Preamble

The House met at half-past Two o'clock

PRAYERS

[MR. SPEAKER in the Chair]

PRIVATE BUSINESS

NORTHAMPTON BILL [Lords]

CITY OF LONDON (SPITALFIELDS MARKET) BILL
(By Order)

Orders for Third Reading read.

To be read the Third time on Thursday 3 November.

LONDON LOCAL AUTHORITIES BILL [Lords]

AVON LIGHT RAIL TRANSIT BILL [Lords]

PORT OF TYNE BILL [Lords]

Orders read for consideration of motions.

To be considered tomorrow.

Oral Answers to Questions — HEALTH

NHS (Pay and Conditions)

Mr. Wareing: To ask the Secretary of State for Health what representations have been made to him by trade unions with members employed in the National Health Service about the pay and conditions of their members.

The Secretary of State for Health (Mr. Kenneth Clarke): Recent representations that I have received have been concerned with the implementation of the clinical grading structure for nurses and the grading review for the professions allied to medicine. Pay settlements have now been concluded for 1988 covering more than 90 per cent. of all National Health Service staff.

Mr. Wareing: In view of the most recent leak—about the Autumn Statement—by this leakiest of Governments, will the Secretary of State tell us how he will ensure the full funding of the pay award to the National Health Service ancillary staff? The AHAs say that £2 billion is necessary even now. Will that necessitate the media going to another Spanish beach before the people in the Health Service are told by the Government that they will receive a real reward for the hard efforts that they have put into the service?

Mr. Clarke: The hon. Gentleman will have to contain himself and wait for the Autumn Statement, which I believe he will find contains quite good news. Meanwhile, I can only remind him that 90 per cent. of our staff have reached satisfactory settlements, and these settlements have now been put into effect for the staff concerned.

Mr. Soames: Will my right hon. and learned Friend accept that his Department's successful achievement in the pay settlement has been received with considerable pleasure? Is he aware that nurses find it difficult to move, especially to the south-east of England, because of the very high cost of housing and living expenses? Does my right hon. and learned Friend agree that the time is fast approaching when we must move to regional pay? What hope can he give that the Government will take that step?

Mr. Clarke: I agree with my hon. Friend, because obviously it is necessary that we recruit and retain people of the required quality in every part of the country. We all know that the costs incurred for staff vary from place to place, as do difficulties in recruitment. We have put in our evidence to the nurses review body the suggestion that we should now move to greater geographical variation and local flexibility, and similar discussions are taking place in the Whitley council about management and administrative staff. I believe that common sense dictates that we should start to reflect local variations in conditions in future pay negotiations for a giant service such as this.

Mr. Orme: Is the Secretary of State aware of the anger and dismay being expressed by nursing sisters about regrading? I have evidence from Hope hospital and Park hospital in the Greater Manchester area and from many other areas. What will the Secretary of State do to resolve that problem?

Mr. Clarke: When the new G grade posts are created in the new year, about three quarters of all sisters will be on the higher grades. If the right hon. Gentleman has found discontented sisters, he has no doubt looked hard and had the assistance of COHSE, which is trying to make difficulties over the minority of sisters who find themselves on the lower grade. The unions agreed to this grading structure, and it is preposterous now to claim that everyone should have gone on the higher of the grades available to sisters. Sisters have been graded according to their skill and the responsibility of the post.

Sir Peter Emery: Will my right hon. and learned Friend make it clear that the fear expressed by a number of health authorities that they could meet the pay award only by reducing services is unjustified? The Government have made extra funds available so that the whole of the award to nurses can be made without any reduction in services within the National Health Service.

Mr. Clarke: Yes, Sir. I am glad that I can give my hon. Friend that assurance. We had to adjust the estimates of the cost as the grading exercise went on and as it became obvious that our first estimate was too low. We have honoured our commitment to fund the cost of the grading exercise in full. We used the regional health authorities' own figures as the basis for doing so, and the authorities have all confirmed that they are satisfied that that funding has been made available in full. That means that there is no reason why patient services should be affected in any way by this desirable improvement in the career structure of nurses.

Mr. Robin Cook: As this is the Secretary of State's first appearance at the Dispatch Box since his appointment, may I welcome him back to Health and express the hope that he will be with us for rather longer than his predecessor? May I invite the Secretary of State to


reconsider his decision of two weeks ago not to meet the trade union side? Is he aware that, in the recollection of the Royal College of Nursing, he is the first Secretary of State who has declined to meet it when requested, which appears all the more odd as his predecessors were doing double the job? Does he agree that most of the 20,000 appeals which are now going through the system could have been avoided if he had agreed to the trade union offer to go to binding arbitration? If he is so confident of his case on regrading, why did he intervene personally to veto arbitration?

Mr. Clarke: First, I thank the hon. Gentleman for his kind words. I look forward to his contribution to our discussions on the Health Service.
I declined to meet the staff side of the Whitley council because it is quite improper for the Secretary of State to put himself in the place of the management side in a negotiating body of that kind. We had plainly reached the stage where continued negotiations were getting us nowhere and where, in my opinion, the trade unions were trying to reopen the basis on which everybody had accepted the grading structure earlier in the year. I concluded that we should get on and implement the Government's declared intention in the new grading structure and provide the funds to meet it.
Of course, I look forward to meeting the staff side of the NHS at some time in the future when we have a sensible agenda and when we are not trying to supplant proper negotiations within the Whitley council.

Doctors (Pay)

Mr. Key: To ask the Secretary of State for Health how much in real terms doctors pay has increased since 1978.

Mr. Kenneth Clarke: Doctors' pay has increased by 36·4 per cent. in real terms since 1978–79.

Mr. Key: May I be first on this side of the House to congratulate my right hon. and learned Friend on his first appearance at the Dispatch Box in his new post—[HON. MEMBERS: "Hear, hear".]—and say how warming it is to find such a robust and positive attitude at the Dispatch Box? Given that the average target pay for general practitioners is now about £28,000 and that that represents only one of a number of variable factors, for which it is hard for anyone to budget, is there any hope of a unitary Health Service as long as we have family practitioner committees? Should not family practitioner committees be abolished and brought within the district authority health service?

Mr. Clarke: I am grateful to my hon. Friend for his remarks and for the lively reaction behind me. I suspect that that will not be the only lively reaction behind me before this day is out.
We are looking at the future of the family practitioner committees, just as we are looking at practically every aspect of the service in the current review. My hon. Friend will recall that we set up the FPCs on their present basis only three or four years ago and, whatever we do, we must ensure that we consider the special qualities of the family practitioner services and of the family doctor service in particular. We do not want the family doctor service to be overlooked by being drawn into the net of the general hospital service.

Mr. Fearn: Will the Secretary of State comment also on the pay scales of junior doctors and tell us whether they have had the same increases during the past 10 years as those he has just mentioned? Will the Secretary of State relate that information to the hours of work that junior doctors are now putting in?

Mr. Clarke: Junior doctors also are much better paid than they were—and certainly they deserve to be, because of their heavy commitment to the service. We are looking yet again at the vexed question of the hours of work of junior hospital doctors, which has been tackled by this Government on more than one occasion and to which I am glad we have made some worthwhile improvements. The fact is that getting things improved requires the commitment of the Government, the authorities and the whole profession. Although at every level the representatives of the profession are fully supportive of what we are trying to do, we sometimes encounter local practice where consultants are not as helpful as they might be about the type of cover that they want. I have also encountered some junior doctors who do not really want their hours reduced because they do not like the fall in pay that goes with it. At the moment we are trying to get rid of one-in-two rotas—and so we ought.

Waiting Lists

Mr. Galbraith: To ask the Secretary of State for Health what reduction in hospital waiting lists he expects after removing those patients who have already had treatment or who no longer require it.

The Minister of State, Department of Health (Mr. David Mellor): Many waiting lists will contain the names of patients who no longer, in fact, require treatment. It is not possible to put a figure on this, although some studies suggest that it could be 10 per cent. or more.

Mr. Galbraith: The Minister is correct. Many studies suggest that the figure is at least 10 per cent. and sometimes as high as 30 per cent. I thank the Minister for that answer and welcome him on his first appearance at the Dispatch Box in his new post.
The Minister will realise that the thinning of waiting lists that takes place when those patients are removed greatly improves the efficiency and delivery of care. What plans has he to ensure that every health authority thins its waiting list in this appropriate manner and therefore improves patient care throughout the country?

Mr. Mellor: I am grateful to the hon. Gentleman for his welcome. I appreciate his expertise in these matters and the non-partisan way in which he has put a question that goes to the heart of our concern. We are keen that waiting lists should realistically reflect the workload of a district. To that end, we have been sending out questionnaires and requests to districts to ensure that they improve their information systems. The new Körner system is giving us much better statistics than we used to have. We also see an obligation to try to improve the mechanisms, whether in human terms or in terms of the machines needed to ensure that proper records are available. It is crucial to the efficient management of a district that we know exactly the state of a waiting list. It should not be swollen by people who do not want an operation after all.

Dame Jill Knight: Will the Minister tell the House the percentage numbers of patients on waiting lists for spare part surgery, where there must obviously be difficulties in moving them from the waiting list?

Mr. Mellor: My hon. Friend is right. One of the major constraints of spare part surgery is the availability of organs to be transplanted. She will have noted the initiative taken by my hon. Friend the Member for Derbyshire, South (Mrs. Currie), the Under-Secretary of State for Health, to encourage more people to carry donor cards, which would assist that process. We are proud of the fact that there has been a marked expansion in spare part surgery. We started heart transplants in 1979 and now have a programme that enables almost 300 a year to be done, and I hope that we shall be able to do more in the near future.

Medical Physics Technicians

Mr. Skinner: To ask the Secretary of State for Health what representations he has received about the pay of medical physics technicians employed in the National Health Service.

Mr. Boateng: To ask the Secretary of State for Health what representations he has received about the pay of medical physics technicians employed in the National Health Service.

Mr. Mellor: A settlement was reached in the appropriate Whitley council on 19 October. Before that, we had received numerous letters from right hon. and hon. Members and individual technicians.

Mr. Skinner: Is not the truth of the matter that, over the past nine years, the people who work in those backroom capacities, in laboratories, have lost ground in relation to other people? Will the Minister confirm that there are currently recruitment difficulties as a result of that? Is it not a scandal that, when the Government are prattling on about a booming Britain, 46·3 per cent. was handed over in wage increases to business executives last year, while these people are having to potter about on single figure pay increases?

Mr. Mellor: I hope very much that business executives will feel further incentives to generate the wealth which we can tax and from which we can pay the wages of medical physics technicians. There are now 30 per cent. more medical physics technicians than there were in 1979 and, although there may be recruitment difficulties in some areas, our innovative ideas on regional pay will help adjust those. I look forward to the hon. Gentleman's enthusiastic support.

Mr. Boateng: Does the Minister recognise that, while business executives are busy generating wealth, the Parkside health authority has problems, not only with recruitment, but with the retention of suitably qualified staff? What special assistance can be given to such health authorities on that difficult problem, which is beginning to affect patient care?

Mr. Mellor: It is a serious problem. I, too, represent an inner London constituency, and I am aware of recruitment difficulties. I am aware also of the problems that are faced by staff who are not beneficiaries of the review body system. We want to try to address these matters. In the

nurses' pay award there was a 9 per cent. additional supplement for inner London, which is the beginning of a move towards regional pay. I believe that that will be the only way in which we can recognise the difficulties that people have in working in the hon. Gentleman's constituency and in mine, as against many areas in the rest of the country where living costs are much lower. I assure the hon. Gentleman that we recognise that there is a problem and that we want to try to do something constructive to resolve it. Any constructive suggestions that he has will be seriously considered.

Mr. Ian Bruce: Does my hon. and learned Friend agree that regional pay is important and that those who do not have the emotional pull of nurses—for example, technicians and others who work in extremely important areas within the Health Service—should not think that the Government ask themselves, "How little can we pay them and get away with it?" We must ensure that market forces are in full play so that we can recruit those who are necessary in technical and other areas. May I have the assurance of my hon. and learned Friend that the Government will work vigorously to introduce reasonable pay differentials so that health authorities in areas such as my constituency in Dorset will be able to recruit staff who are essential for technical departments?

Mr. Mellor: I think that both my right hon. and learned Friend the Secretary of State and I were nodding in assent during my hon. Friend's supplementary question, which made the central point that all those who work within the service are valuable to it. We must ensure that every group is properly considered, and that is more easily said than done. It is plain that there is room in which to examine the issue, and we shall do so.

Rev. Martin Smyth: I welcome the Minister's response to the hon. Member for Brent, South (Mr. Boateng), but I ask him to reconsider his use of percentages to show a decided increase in staffing levels. Does he recognise that over the years there has been. a tremendous advance in the use of science and technology in the service of medicine? That being so, there will be an increase in numbers. Will he recognise also that sometimes some of those who are included in the numbers that are returned are not in post for various reasons? Will he accept that perhaps we are overstraining the commitment of medical staff and technicians to the Health Service and their care of patients?

Mr. Mellor: I am not quite sure what point the hon. Gentleman was making in the first part of his supplementary question. Self-evidently, unless there were a good reason for appointing 30 per cent. more staff in any given grade, the Government would stand condemned for wasteful employment of unnecessary people. It is clear that there has been an increase in high technology medicine. That has required more staff in certain grades and a mass of others in the service with greater qualifications. Our job is to try to ensure that our increased resources touch on the conditions of these people and allow us to recruit the numbers that we need to keep the service going. We must ensure that we look to some of the lesser groups and not only the large groups. We must bear in mind those who do not necessarily have the public emotional clout of some others in the service.

NHS (Value for Money)

Mr. Brandon-Bravo: To ask the Secretary of State for Health how he intends to improve value for money in the National Health Service.

Mr. Kenneth Clarke: We remain committed to ensuring that health authorities continue to improve efficiency in all areas in order to maximise the resources available for patient care. We expect authorities to look critically at all their unit costs, including supplies, energy and, increasingly, clinical costs. Substantial progress has already been made by authorities with over £700 million worth of cost improvement savings expected to have been diverted into providing patient services by the end of this financial year. Health authorities have increased the number of patients they have treated at a faster rate than the increases in their expenditure, and they should continue to do so.

Mr. Brandon-Bravo: I am sure my right hon. and learned Friend will agree that few reasonable people would quibble with the concept of value for money in the Health Service or anywhere else in the public service. I seek assurances on behalf of the well-run districts which believe in value for money and sensible budgeting, and understand that there are 12 months in a year, and not 10 or 11, as some districts seem to think. I ask for an assurance that sensible, well-run districts will not lose money as a result of the activities of profligate ones, and that their income will be properly protected.

Mr. Clarke: I can give my hon. Friend that assurance. The Department allocates all its money each year and does not keep any in reserve centrally. Authorities receive their allocation—allocations are based on the same principles throughout the country—to improve their patient services by a combination of the new money and their efficiency in making use of it. It would be wrong to raid the budgets of better-run districts to help those who get into difficulties. The Health Service sees increasingly that authorities have the remedy in their own hands when they face any short-term financial problems.

Dr. Moonie: Does the Minister agree that the poorest value for money in the Health Service arises from closing acute units for two months at the end of the year? Will he guarantee that that disgraceful situation which occurred in the Health Service last year will not be repeated this year?

Mr. Clarke: I covered that point in reply to my hon. Friend the Member for Nottingham, South (Mr. Brandon-Bravo). We allocate money in England on the same basis to all authorities, using the RAWP formula. The vast majority of health authorities are extremely successful at using that money, increasing their efficiency and increasing the number of patients they treat. Obviously all the authorities face difficult problems and some get into difficulty with their services. I believe that we have provided the funds to enable the service to be expanded and we should see a reduction in local difficulties which crop up from time to time.

Mr. Latham: Does my right hon. and learned Friend accept that mothers-to-be will not regard it as value for money if the Leicestershire health authority tries to close all rural maternity units? Will he tell the authority that such policies are simply not acceptable in rural areas?

Mr. Clarke: We have a well-tried procedure whereby there is full consultation about proposals of that kind. Eventually the proposal comes to my Department and my hon. and learned Friend the Minister of State would have to approve any closure proposal. There are long-standing arguments all over the country about whether the service is most effectively provided in small maternity units or in the maternity sections of large district general hospitals. If the proposal comes to us, we will look very carefully at the particular situation in Leicestershire and at any representations that my hon. Friend and his constituents wish to make.

Mr. Allen: Does the Minister agree that the best value for money is to be found in preventive medicine rather than in trying to treat ailments after they have developed? Will he therefore even at this late stage read the document produced by his district health authority's local dental committee and the document from the local optometrists, which demand that the changes in the amounts charged for dental examinations and eye tests should not proceed today? Will he read those documents?

Mr. Clarke: I have read those documents, and obviously it would be most sensible for me to address myself to the arguments that they contain later, when the hon. Gentleman and I will have an opportunity to debate the matter. Of course I agree that preventive medicine is the best value and should be encouraged. I do not agree that the proposed charges will reduce the amount of preventive medicine. I would regard a decision to keep the charges in the pockets of the six out of 10 of the better off who will be liable to them as a very poor use of resources which could be put to much better use elsewhere in the Health Service.

District Health Authorities'

Mr. Hunter: To ask the Secretary of State for Health if he will make a statement on the variations in efficiency between different district health authorities.

The Parliamentary Under-Secretary of State for Health (Mrs. Edwina Currie): The actual cost per in-patient case in 1986–87 varied from £456 to £1,117 in non-teaching districts and from £699 to £1,334 in teaching districts. At least part of those substantial variations remain unaccounted for. We are certain that there is still scope for some authorities to make better use of resources to improve services to patients.

Mr. Hunter: Does not my hon. Friend's answer show the value of performance indicators in assessing relative efficiency and, further to what has just been said, that many health authorities still have a very long way to go to improve their efficiency in spending taxpayers' money?

Mrs. Currie: Oh yes. I am sure that my hon. Friend is aware of the Health Service indicators for the Basingstoke and North Hampshire district health authority, which covers his constituency. The average looks OK, but when we analyse them more clearly it is clear that Basingstoke's throughput is low, the length of stay is too long, the turnover intervals—the length of time that beds are vacant between patients—are too high and the length of time to clear the waiting list is too long. Basingstoke is being reviewed today by the regional chairman and no doubt he will take note of the figures.

Mr. Eastham: Is the Minister aware of the growing bad reputation of the National Health Service as a late payer? As a consequence it is losing discounts on purchasing equipment. Crumpsall hospital in Manchester is so short of equipment that even in the casualty ward there was a shortage of drip equipment. Is that the kind of thing the Minister thinks about when she refers to value for money?

Mrs. Currie: The hon. Gentleman has asked two different questions. I agree with the first part of his question. We do not regard it as a good idea to be late payers. Apart from anything else, that simply pushes up the price of the equipment that we have to purchase. I take note of the second part of his question and will contact him to tell him exactly how the situation stands.

Dame Elaine Kellett-Bowman: Will my hon. Friend ensure that districts such as Lancaster, which do well in performance indicators, are not penalised for the benefit of those which do less well, such as some of those represented by Opposition Members?

Mrs. Currie: My hon. Friend is right. The cost per case in Lancaster is £625, which is well below the national average. However, I hope that the Lancaster health authority will not be complacent and will ensure that it obtains the maximum amount of patient care for that money.

NHS (Pay and Conditions)

Mr. Pendry: To ask the Secretary of State for Health what representations he has received about the pay and conditions of service of ancillary staffs in the National Health Service.

Mr. Mellor: Since the last time this matter was raised during questions on 12 July we have received three letters from right hon. and hon. Members and six from members of the public.

Mr. Pendry: Will the Minister take it from me that should, in the current negotiations, the management side of the Whitley council not recognise the essential part that those overworked and underpaid workers in the NHS play, he will be receiving strong representations from the union side? If the talks end in deadlock, as seems likely, will he give a guarantee now that he will use his best endeavours to ensure that both sides in the pending dispute go to arbitration?

Mr. Mellor: We have enough trouble already without anticipating trouble that may not come. The hon. Gentleman's predictions about what may or may not happen at the end of a pay round that has barely begun do not excite my interest at the moment. The hon. Gentleman does us a disservice. During the course of the previous negotiations the 40-hour week was reduced to 39 hours, which meant that the lowest basic hourly rate for ancillary workers was increased by 9 per cent. That is a much better deal than they obtained under the Labour Government when, he might like to recall, the pay of ancillary workers fell 10 per cent., compared with an increase in spending power during the Conservatives' reign.

Mr. John Townend: Does my hon. and learned Friend agree that the higher that wage settlements in the NHS are in the coming year, the less money will be available for improvements in patient care?

Mr. Mellor: Yes. One thing is absolutely clear. Some people talk about the NHS as though it was merely a basis for increased pay for those who work within it. Already we know that of the substantial resources that go into the NHS, over 70 per cent. goes towards the pay of those who work within it. We recognise that one of the greatest assets of the service is the skills of those who work within it, but a lot more needs to be done and, plainly, improving patient services is something to which we intend to give even greater priority than we have in the past.

Nurses (Pay)

Mr. Haynes: To ask the Secretary of State for Health what is his latest estimate of the cost of funding the nurses pay settlement; and what plans he has to fund it in full.

Mr. Kenneth Clarke: I announced on 13 October additional financial allocations to English regional health authorities to meet in full, the best estimates of the final costs of the nurses' pay settlement, including the clinical regrading exercise. An additional £98 million has been made available, bringing the total cost for England to £731 million.

Mr. Haynes: Is the Secretary of State aware that he has let the nurses down? He has broken a promise to the nurses. The Secretary of State represents a constituency just down the road from mine. I have had nurses from all their organisations coming to have a go at me at my surgery on a Saturday morning when they should have been having a go at him. There is no doubt that, because of what he has said at the Dispatch Box today, he is not holding surgeries to have those nurses come to see him. I want to know whether the Secretary of State will live up to his promise and give the nurses the money to which they are entitled.

Mr. Clarke: I, too, hold my surgeries on Saturday mornings and my constituency is so close to that of the hon. Gentleman that I can almost hear him addressing his constituents. The announcement that we have made honours in full every commitment that we gave to the nursing profession. It represents on average a 17·9 per cent. increase across the country and it is the best deal that the nurses have ever had in the NHS.

Mr. John Marshall: Will my right hon. and learned Friend confirm that, following the nurses' pay increase, their salaries will be 45 per cent. higher in real terms than they were in 1979?

Mr. Clarke: That is absolutely correct. It contrasts with a drop of 20 per cent. in real terms that took place during the period of office of the Labour Government.

Ms. Harman: Will the Minister agree to meet myself, the nurse managers for nurses in hospices and Help The Hospices, which is the umbrella organisation for hospices, to discuss our concern about the effect of the pay award on nurses in hospices? What financial arrangements will he make for pay awards for nurses working in hospices that currently receive no grant from their district authority, such as St. Oswald's in Newcastle, St. Clare's in South Shields, and the Hartlepool hospice?

Mr. Clarke: I can assure the hon. Member that a Minister from my Department will meet her deputation. Obviously it will be left for the most convenient


arrangements to be made when she contacts my office. We remembered the hospices in the settlement that we made, although their case was not pressed upon us by anyone in the trade union movement; perhaps the hon. Lady may have done so. We have made a provision of extra money to cover regrading and pay increase costs in those hospices that currently have a relationship with health authorities. We are still discussing how best to distribute it, and we shall listen with interest to whatever the hon. Lady has to say on behalf of individual hospices throughout the country.

Mr. Harry Greenway: Will my right hon. and learned Friend confirm what was said by his predecessor, that under the award, nurses will receive equal pay for equal work and responsibility, but that it will be made clear that some nurses have more responsibility than others in the work that they have to do, and that that is a crucial factor in deciding whether they are graded G or F?

Mr. Clarke: My hon. Friend is right, and seeking to ensure that such is done on the right basis throughout the country has been a complicated process. I think that that exercise has been extremely successful. In some cases a new G-grade post will have to be created. My hon. Friend is right to say that there will have to be some competition, so that the health authority may choose the best candidate for the extra skill and responsibility involved. We have ensured that once that skill and responsibility is being carried, it will be properly paid for under the new arrangement.

Mr. Win Griffiths: To ask the Secretary of State for Health what representations he has received on the implication of the nurses pay award.

Mrs. Mahon: To ask the Secretary of State for Health what representations he has received from trade unions and professional bodies with members in the nursing profession about the recent pay award.

Mr. Kenneth Clarke: The Government's decision to provide substantial additional funding to meet in full the estimated final costs of the nurses' pay settlement has been welcomed by health authority chairmen and managers and by responsible representatives of the trade unions and professional bodies.

Mr. Win Griffiths: Does the Secretary of State agree that his cavalier refusal to meet the nurses' organisations at an earlier point in the disagreement arising out of the current pay dispute has resulted in poor morale in the Health Service? Although the Minister has so far committed himself to paying the estimated cost of the award, it could yet be that the award will be still higher than the level of money currently being discussed. In those circumstances, will the Secretary of State guarantee that further money will be made available?

Mr. Clarke: The morale of all Health Service staff would be raised if the Government, management and trade unions all took part in responsible discussions on these matters. At certain stages in the negotiations over the detail of the grades and structure, I believe that people were seeking meetings with me more for the benefit of securing publicity for themselves than for the purpose of furthering the nurses' pay settlement.
The money that we have found—which is a very substantial sum of almost £1 billion for the United

Kingdom as a whole—is in full and final settlement of the cost of implementing the new arrangements. It is based on the regional health authorities' own figures. Clearly, we must now put that behind us and concentrate on what is now in hand, which is the giving of evidence before the nurses' review body for next year's settlement.

Mrs. Mahon: If the Minister believes that he has treated the nurses very generously, can he explain to the House why so many nurses and midwives are angry and have seen through his outrageous regrading swindle?

Mr. Clarke: Certainly one of the trade unions involved is having remarkably little success in its continued attempts to find nurses with a sense of grievance about the settlement. I regret the fact that some trade union leaders continue trying to find opportunities for dispute. I particularly deplore the fact that they are trying to organise industrial action in one or two places up and down the country. I am sure that they will not succeed, and I am sure also that the public recognise that the great bulk of the nursing profession is very satisfied with such a very generous award.

Mr. Ralph Howell: In 1985 my right hon. and learned Friend's Department was unable to tell the Public Accounts Committee whether we were employing too many or too few nurses. Can he tell us now whether there are too many or too few?

Mr. Clarke: We certainly have much better information than we had a few years ago about the number of staff whom we employ, and we are improving the quality of nurse management. Now that we have given them a new career structure, it is extremely important that those responsible for the management of the skilled professional staff make the best possible use of their trained manpower. We are looking for the best deployment of nurses in all grades to ensure the maximum quality of service for patients.

Mr. Ieuan Wyn Jones: I am sure that the Secretary of State will have read in yesterday's Western Mail that nurses in Wales are not to be paid their new rates or be regraded at the same time as their colleagues in England, because the Treasury has intervened. Will he now consult urgently with the Secretary of State for Wales so that they can go back to the Treasury and say that nurses in Wales are entitled to the same pay rates as their counterparts at the same time?

Mr. Clarke: I regret to say that I have not read the Western Mail, and this is plainly a matter for my right hon. Friend the Secretary of State for Wales. However, the regrading exercise was carried out on exactly the same basis in Wales as it was in England, and should produce the same satisfactory conclusion for nurses and midwives in both countries.

NHS (Review)

Mr. John Garrett: To ask the Secretary of State for Health when he expects to publish the results of his review of the National Health Service.

Mr. Cohen: To ask the Secretary of State for Health when he expects to publish the results of his review of the National Health Service.

Mr. Kenneth Clarke: We shall bring forward a White Paper in the new year.

Mr. Garrett: Does the Secretary of State expect the review to confirm the principle of a tax-funded National Health Service, or does he expect it to follow his charges for preventive tests, with charges for accommodation and food in hospitals? Or is he waiting for the Prime Minister to make up his mind for him?

Mr. Clarke: The hon. Gentleman will have to wait for the review, but I can assure him that it will be consistent with our policy of seeking to improve and develop the NHS. As for the charges, it was a Labour Government who, in 1951, introduced the principle of payment for dental, optical and pharmaceutical services by those who could afford it. The Labour party has never gone back on that, except for a very short period. Labour raised charges when it was in office, and it is obvious that this is a sensible way of raising revenue to finance the considerable expansion of the NHS that we are implementing.

Mr. Cohen: Is not creeping privatisation the cup of poison that the Government have planned for the NHS? Are they not planning a further rundown in the NHS to help the rise of the private sector, although that sector does not train nurses but only steals them from the NHS? Will not this pernicious privatisation mean more personal bankruptcies from bad health and the shrinking of available treatment on the NHS?

Mr. Clarke: The answer to all three questions is no. The hon. Gentleman should not base questions on such a parody of our policies after a period when we have plainly improved the NHS greatly, compared with its performance under the preceding Labour Government.

Mr. McCrindle: If, as my right hon. and learned Friend seems to suggest, there is a certain slowing in the pace of the NHS review, will he take the opportunity to focus particularly on treatment of the elderly? Although I do not exclude the advantages that the elderly can gain from private health insurance, will my right hon. and learned Friend try to appreciate even more than he does now that the elderly rely perhaps more heavily than any other section of the community on provision by the NHS?

Mr. Clarke: We welcome all contributions to our discussions while they continue, and I certainly welcome any from my hon. Friend. One reason why demands on the NHS continue to rise so inexorably is that an ever higher proportion of the population are living into old age and need to have more recourse to the service. We have so far managed to keep ahead of that rising demand, and we must continue to do so.

Mr. Yeo: When my right hon. and learned Friend publishes his White Paper, will he address the question of AIDS? Bearing in mind the lack of accurate information about the rate at which the virus is spreading, will he introduce at the earliest opportunity a system of anonymous blood tests so that future policy can be formed on the basis of accurate information?

Mr. Clarke: As my hon. Friend knows, we are making available considerable resources to deal with the advance of this pandemic. We must continue to do so on the best estimates we have of the continued increase in patients. We

are actively considering anonymous testing as a contribution to studies of the epidemic, but it raises a number of difficult ethical and legal problems.

Mr. Robin Cook: In reaching his conclusions on the review of the NHS, will the Secretary of State bear in mind the warning provided by the experience of Mrs. Veronica Barnes, who, despite paying 40 years' subscriptions to Private Patients Plan, has had her cover for treatment for cancer withdrawn. Will he give weight to her observation:
Private insurers seem keen enough to get you when there is nothing wrong with you, but as soon as you are really ill, they don't want to know.
Does not her case demonstrate the danger of running down the NHS to boost private medicine and show precisely why we need to keep the service free to everybody when they need it?

Mr. Clarke: It is ridiculous to say that the Government are running down the National Health Service, when one compares our nine-year record with that of our predecessors. I only hope that the hon. Gentleman's random question, with a letter from one person, is not part of his support to his junior spokesman, who is still conducting attacks on private medicine more suitable to the politics of the 1960s than today. It is obvious that in a more prosperous society an ever-higher proportion of the population will look to private insurance for part of their health treatment. That is a good thing, because it relieves pressure on the National Health Service.

Oral Answers to Questions — PRIME MINISTER

Engagements

Ms. Walley: To ask the Prime Minister if she will list her official engagements for Tuesday 1 November.

The Prime Minister (Mrs. Margaret Thatcher): This morning I presided at a meeting of the Cabinet and had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall be having further meetings later today.

Ms. Walley: When the take-up of family credit is as low as one in three, how can the Prime Minister justify the sacking of 4,400 civil servants? Does she agree that those people would be best employed increasing the take-up of benefit in places such as my constituency of Stoke-on-Trent, North?

The Prime Minister: No. The work of the social security officers in dealing with the unemployed has reduced substantially. I am sure that the hon. Lady is very pleased about that. That also applies to social security offices. There is no point in keeping on people who have no work to do. Where we need extra efficiency, we are trying to get it by improved use of all the latest office equipment. Where we need people to do specialist work we shall take them on, but we shall take on only a particular kind of person.

Mr. John Townend: To ask the Prime Minister if she will list her official engagements for Tuesday 1 November.

The Prime Minister: I refer my hon. Friend to the reply that I gave some moments ago.

Mr. Townend: Does my right hon. Friend agree that those who have benefited most from the substantial


reductions in income tax, particularly those on high incomes, should be prepared to accept the personal responsibility of paying for their own eye tests and dental examinations? Will she make it clear that it is not Government policy, it never has been and it never will be, to levy charges on children, the low-paid and the partially blind? Will she confirm that 20 million people will be exempt from such charges?

The Prime Minister: My hon. Friend is correct in saying that some 20 million people—more than one third of the population—will be exempt from charges on sight tests and dental examinations. Most people can pay small charges for dental and eye examinations. They are very willing to pay small charges. They cannot pay the big charges for operations for cataracts, hip replacements and so on. [Interruption.] Small charges amount to a very considerable sum which enables us to have reductions in waiting lists, such as the initiatives we have had in the past. If we are deprived of those small sums, people will not be able to get the operations they really need as soon as they otherwise would. Many people would be quite put out if they were not allowed to pay—[interruption.]

Mr. Speaker: Order. The Prime Minister has not finished answering the question.

The Prime Minister: Many people would feel that it was quite wrong if they were not allowed to pay the small sums which they can well afford, to enable substantial developments in the Health Service to take place.

Mr. Kinnock: There is now conclusive proof that family credit reaches only 30 per cent. of eligible families. When a targeted benefit misses 70 per cent. of the people it is supposed to help, had the Prime Minister not better do something about her aim?

The Prime Minister: My right hon. Friend the Secretary of State for Social Security has said that we shall have a major effort to get more people who are entitled to family credit to receive it. That will mean, among other things, a major programme of television advertising. I hope that the right hon. Gentleman will not then object to that expenditure.

Mr. Kinnock: Is the Prime Minister not aware that, at the outset of family credit, the Government budgeted for only 60 per cent. take-up? Actual take-up has been half that. Does that cause the Government and the Prime Minister any regret, or is it yet another attempt to ensure that money can be saved at the expense of the poor?

The Prime Minister: More money is being spent on the poor and not on better-off people. The right hon. Gentleman is aware that people can claim family credit with a family of two up to an income of £9,300 a year. I would have hoped that the right hon. Gentleman would join in trying to get people who are entitled to family credit to go along and claim it. If he will not, why not?

Mr. Kinnock: I am rather more in favour of the poor getting money than is the Prime Minister, on the basis of her record. Last week the Government again froze child benefit. They spent £70 million on family credit. If the Prime Minister is so keen to provide money for the poor, why did she not spend the whole £206 million previously earmarked for child benefit on providing family benefit for

people who are most greviously in need of it as a result of the means tests that the Government have applied to them?

The Prime Minister: Never has more been spent on social security payments and the Health Service, because the wealth created by enterprise under this Government has enabled us to do that. Family income supplement, as it used to be, was introduced by a Conservative Government. Family credit—an enormous improvement which helps people on low wages—was also introduced by a Conservative Government. There have been no such things under Labour.

Mr. Adley: I welcome my right hon. Friend's continued support for the Channel tunnel project. Is she aware that there appears to be no co-ordination between the British Government through British Rail and the French Government through Societé Nationale des Chemins de fer Francais of the investment criteria governing the construction and development of rail services at each end of the line? Does my right hon. Friend think that this is necessary? If so, will she please arrange for the two Departments of Transport to meet soon to discuss the matter?

The Prime Minister: I would not necessarily accept that. I think that there is co-ordination. I think that my hon. Friend is probably referring to the fact that the French need the high-speed train in any event, whereas we do not have the same need for it on this side of the tunnel for services to London. I will, however, look further into the matter.

Sir Russell Johnston: Is the Prime Minister aware that those of us who struggle with tobacco addiction—it is some struggle, as I am sure the Leader of the Opposition agrees—are interested to read speculation that she is contemplating some legislation in this area? Is she aware that in West Germany for example, tobacco companies are compelled by law to print on cigarette packets the nicotine and carbon content of cigarettes, thus at least enabling people to choose the least injurious? Will she consider leaning on tobacco companies to do that voluntarily in the United Kingdom?

The Prime Minister: I am not aware of any further legislation. The health warning on the packet does not seem to have had very much effect. Persuasion is a far better weapon than legislation on this issue.

Single European Act

Mr. Teddy Taylor: To ask the Prime Minister if she will raise at the next meeting of the European Council the question of the use by the Commission of the powers given it in the Single European Act.

The Prime Minister: No, Sir. The Single European Act did not confer additional powers on the Commission and the power of final decision remains with the Council of Ministers. The Commission has used its existing powers to bring forward proposals for the completion of the internal market, as required by the Single European Act. I do not see a need for any increase in its powers.

Mr. Taylor: Does not the message of my right hon. Friend's splendid speech at Bruges point out the real danger that the much publicised free trade in 1992 will be


a major disappointment and let-down for Britain so long as the Commission, under Mr. Delors, uses the powers of the Single Act to promote pointless measures of harmonisation instead of putting forward the real free trade measures so very much required by British industries such as the insurance industry? Is there really nothing that the British Government can do to stop the Commission from using its anti-dumping powers as a measure of blunt protectionism?

The Prime Minister: I agree with my hon. Friend that this is a matter on which we must remain watchful. We want the single market and the Common Market to come into effect by 1992. We do not want to see highly complex regulations or new barriers set up around the Community. We want freer trade and the restraints on trade removed. We shall be watchful so that we do not have a complex plethora of new regulations. Where the regulations are particularly important, as in tax and the movement of peoples, all of us in the European Community have arranged to require unanimity to bring those directives into effect.

Mr. Spearing: Does the Prime Minister realise that Mr. Delors was wrong in the 80 per cent. forecast? Is she not aware that we have already, since 1958, reached that forecast of EEC legislation, let alone the amount in 10 years' time? Does that not suggest that the prime problem is not a future United States of Europe, but the legislative competence which is already enjoyed by the unitary but interlocking institutions of the EEC? What legislative competence for originating legislation is beyond that of the Commission today?

The Prime Minister: The Commission is committed to carrying forward all the programme of some 300 measures in its 1985 White Paper. The hon. Gentleman is very much aware of that. Where there is an extremely important directive, for example on tax matters, there must be unanimity, and therefore we would have to vote for it. Where there is any change in legislation in terms of the treaty, that matter, too, must come before the House. I know that the hon. Gentleman is keen that we should have maximum scrutiny of all these orders. It is very necessary that we do.

Sir Ian Lloyd: My right hon. Friend has opened up in her characteristically forthright and effective way a major debate on the future political structure of Europe. Does she ever envisage a time when a representative of the Council of Ministers stands before the Dispatch Box of the

European Parliament as she does at the Dispatch Box here, answering for the policies and actions of that Council over which national Parliaments no longer have effective control and over which the European Parliament has not yet gained any influence?

The Prime Minister: I would not quite like to forecast that, but it has been impressed upon me that the Parliaments in other countries belonging to the European Community do not seem to have quite the cross-examination process to which Ministers are subjected in this country. Therefore, Parliament does not play such a central role in some of those countries as it does in ours.

Mr. Bernie Grant: Will the Prime Minister confirm that Commonwealth citizens who presently have the same status as British citizens—

Mr. Speaker: Order. I remind the hon. Gentleman that the question is on the Single European Act.

Mr. Grant: My question is on the European Act. Will the Prime Minister confirm that those citizens will have the same status after 1992 as they do now—the rights to vote and to stand for Parliament, and so on?

The Prime Minister: As far as I am aware, the 1992 Act does not alter that. We are concerned that the immigration rules which we have now shall not be affected by the Single European Act. We are concerned to keep controls at borders to ensure that that is so.

Mr. Patnick: To ask the Prime Minister if she will list her official engagements for Tuesday 1 November.

The Prime Minister: I refer my hon. Friend to the reply that I gave some moments ago.

Mr. Patnick: Is my right hon. Friend aware of the growing action of local communities, highlighted by the Daily Express, in removing litter, graffiti and fly posting from our streets? Should that not be encouraged and more people involved so as to rid this blot from our streets, towns and cities?

The Prime Minister: I wholly agree with my hon. Friend. There could be a major improvement in the appearance of our towns and cities if people did not throw down litter, if any litter thrown down was promptly picked up and if people did not leave large black refuse bags outside restaurants and shops in London. I congratulate Tidy Britain Group on its efforts. I also congratulate the Daily Express on its effort and I am delighted that so many groups have been organised to keep Britain tidy.

Autumn Statement

The Chancellor of the Exchequer (Mr. Nigel Lawson): With permission, Mr. Speaker, I should like to make a statement.
Cabinet today agreed the Government's public expenditure plans for the next three years. I am therefore taking the earliest opportunity of informing the House of the contents of the Autumn Statement: that is to say, the public expenditure plans for the next three years, and the expected outturn for this year; proposals for national insurance contributions for 1989–90; and the forecast of economic prospects for 1989 required by the Industry Act 1975.
The main public expenditure figures, together with the full text of the economic forecast, will be available from the Vote Office as soon as I have sat down. They will also appear in the printed Autumn Statement, which will be published next Tuesday.
I turn first to public expenditure. For the current financial year, 1988–89, the public expenditure planning total now looks likely to amount to some £153½ billion, or some £3¼ billion less than was allowed for in the last public expenditure White Paper. In other words, only around £¼ billion of the £3½ billion reserve I provided for is in fact likely to be needed.
The main reasons for this shortfall are an extra £1 billion in privatisation proceeds, a reduction in social security spending of almost £1 billion as a direct result of the sharper than expected fall in unemployment and a saving of some £¾ billion largely due to extra housing receipts under the right-to-buy programme. Taken together with the strong growth in the economy this year, and the containment of debt interest now that the Budget is in surplus, this means that total public spending this year, even excluding privatisation proceeds, will be less than 40 per cent. of national income—the first time this has happened for over 20 years.
Not so long ago, the share of national income spent by the state seemed to rise inexorably. Over the past six years, that trend has been decisively reversed. Since 1982–83, public expenditure, excluding privatisation proceeds, expressed as a share of national income has fallen by seven percentage points—the largest and longest sustained fall since the wartime economy was unwound. Over the whole decade since this Government first took office, from 1978–79 to 1988–89, public expenditure has grown by under 1½ per cent. a year in real terms. This is exactly half the rate at which it grew over the whole of the immediately preceding decade.
Looking ahead, Cabinet agreed in July that public spending over the next three years should keep as close as possible to the existing planning totals, and should continue to fall as a share of national income. The plans I am about to announce meet both those objectives.
For 1989–90, the planning total published in the last public expenditure White Paper was £167 billion. It will remain at £167 billion. This important outcome has been made possible, despite the many claims for increased public spending, by a rigorous reassessment of priorities, coupled with the continuation of two of the factors that have contributed to this year's shortfall; that is to say, benefit savings from lower unemployment and increased receipts from council house sales.
For 1990–91, however, though these two factors will persist, the planning total has been set at £179½ billion, some £3¼ billion more than the previously published figure. For 1991–92, the planning total has been set at £191½ billion. These totals all include the same level of reserves as in last year's plans; that is to say, £3½ billion in the first year, £7 billion in the second year, and £10½ billion in the third. They also incorporate an unchanged estimate of privatisation proceeds of £5 billion a year.
Over the three survey years as a whole, the real growth in spending on programmes will be over 3 per cent. a year. This can be afforded only because of the fall in the burden of debt interest brought about by the dramatic improvement in the Government's finances from Budget deficit to Budget surplus. As a result, overall public spending, excluding privatisation proceeds, will rise by less than 2 per cent. a year, well within the prospective growth of the economy as a whole. In other words, total public spending, excluding privatisation proceeds, will continue to decline as a proportion of national income. At the same time, substantial additional funds have been made available for the Government's most important public expenditure priorities.
The figures which I am about to give all represent increases over the plans in the last public expenditure White Paper.
First, health. An extra £1¼ billion—£1¾ billion—is—[Interruption.] An extra £1¼ billion—[Interruption.]

Mr. Speaker: Order. This is a very important statement, and I am sure that the House wishes to hear it.

Mr. Lawson: An extra £l¼ billion is being provided for the National Health Service in England in 1989–90—[Interruption.] The Opposition may not be interested in the National Health Service, but we on this side of the House are interested in it and are providing a lot more money for it.
An extra £1¼ billion is being provided for the National Health Service in England in 1989–90, and an extra £1½ billion the following year. There will be corresponding increases in Scotland, Wales, and Northern Ireland. On top of that, health authorities are expected to receive an extra £100 million a year from sales of surplus land. Continuing the rate of cost improvement savings achieved in recent years will produce an extra £150 million in 1989–90 and an extra £300 million the following year.
In addition, the Government are accepting the recommendation of the Government Actuary, in a report published today, that NHS employers' superannuation contributions in England and Wales should be reduced, which will save the Health Service a further £300 million a year.
In total, the increases for the Health Service in the United Kingdom as a whole will be over £2 billion in 1989–90 and over £2½ billion in 1990–91. These are by far the largest increases the Health Service has ever received. Comparing next year with this year, the increase in real resources for the NHS should amount to some 4½ per cent.
Second, roads. An extra £220 million is being provided next year for building and repairing motorways and trunk roads, and for strengthening bridges, with a further £250 million the following year.
Third, housing. Gross provision for public sector housing investment is being increased by around £440


million in 1989–90 and £340 million the following year. But thanks to the success of the Government's right-to-buy policy, this is more than financed by extra receipts.
Fourth, law and order. An extra £290 million has been made available in 1989–90 and £430 million in 1990–91, principally for a further expansion in the prison building programme. This will provide a further 3,000 places by 1991–92. Provision for local authority spending on the police has been increased by £240 million.
Defence spending is to be increased by £150 million in 1989–90 and by £600 million in 1990–91. These significant increases are designed to provide a firm framework for the next three years within which our defence programme can be planned with confidence.
So far as the massive social security budget is concerned, lower unemployment has saved more than £1½ billion in both 1989–90 and 1990–91. But substantial increases in planned spending on other benefits, particularly for the disabled, mean that the social security programme will be only marginally reduced in 1989–90 compared with previous plans, and some £1·7 billion higher in 1990–91.
On science and technology, we have altered the balance of public support within an increased total. In particular, provision for spending by the Department of Education and Science has been increased by £120 million a year, with the DES science budget up by 16 per cent. in 1989–90 compared with 1988–89. This reflects the importance the Government attach to basic and strategic research.
The new plans imply an overall increase of £2¼ billion in public sector capital spending in 1989–90. This includes extra investment in hospitals, housing, prisons, and roads. There is provision, too, for higher investment by the nationalised industries, including further anti-pollution investment by the water authorities.
That the Government have been able to strengthen their priority programmes within an unchanged planning total for 1989–90 is, in large measure, a reflection of the success of their policies. The improved performance of the economy has eased pressures on a number of programmes, giving the Government more scope than ever before to shift resources where their own priorities, rather than circumstances, dictate. The details of these and other changes are provided in the material in the Vote Office and more details will be published in the printed Autumn Statement next week.
I turn next to national insurance contributions. The Government have conducted the usual autumn review of contributions in the light of advice from the Government Actuary on the prospective income and expenditure of the national insurance fund, and taking account of the statement on benefits which my right hon. Friend the Secretary of State for Social Security made last week.
The lower earnings limit will be increased next April to £43 a week, in line with the single person's pension, and the upper earnings limit will be raised to £325 a week. The upper limits for the 5 per cent. and 7 per cent. reduced rate bands will also be increased, to £75 a week and £115 a week respectively. The upper limit for the 9 per cent. rate for employers will be raised to £165 a week.
Over recent years, we have steadily reduced the Treasury supplement, the taxpayer's contribution to the national insurance fund. From 18 per cent. in 1979, it now stands at 5 per cent. My right hon. Friend and I now

propose to carry this policy to its logical conclusion and to abolish the supplement altogether. The necessary legislation will be introduced early in the new Session.
However, because of the healthy state of the national insurance fund, this decision will not require any increase in contribution rates. Thus, the main class I contribution rates will remain unchanged at 9 per cent. for employees and 10·45 per cent. for employers.
Finally, I turn to the Industry Act forecast. Growth this year looks to be turning out at 4½ per cent. compared with the 3 per cent. growth forecast at the time of the Budget. Investment is particularly strong, growing twice as fast as consumption, with manufacturing investment expected to show the biggest rise of all, at 18 per cent. Indeed, it is striking that total investment has grown almost twice as fast as total consumption over the whole of the past five years.
The continuing vigour of the British economy is testimony to the transformation that has taken place in the supply side of the economy, a transformation which has enabled the seven years to 1988 to record a combination of strong and steady growth unmatched since the war.
As a result, unemployment has been falling rapidly. Since the middle of 1986, it has fallen by very nearly 1 million—the largest fall on record. Over the past year, unemployment has fallen faster in the United Kingdom than in any other major country.
Inflation, as measured by the retail prices index, is likely to be a little over 6 per cent. in the fourth quarter of this year. Part of the rise in recorded inflation reflects the impact on mortgage payments of the higher interest rates needed to tighten monetary policy and thus get inflation firmly back on a downward trend. Excluding mortgage interest payments, the RPI in the fourth quarter is likely to be around 5 per cent., compared with the 4 per cent. rise in the RPI forecast at the time of the Budget.
Exports have continued to perform well, with manufactured exports up 7½ per cent. over the past year. Over the past seven years, the United Kingdom's share of world trade in manufactured goods has remained steady after decades of decline. However, with investment booming, and consumer spending increasing fast, total imports have grown even faster than exports, rising by 13 per cent. in the year to the third quarter. This has led to a substantially greater current account deficit than forecast at the time of the Budget. For 1988 as a whole, this now looks like turning out at some £13 billion, equivalent to 2¾ per cent. of GDP. The stronger than expected economic growth this year means that total tax revenues are likely to exceed the Budget forecast by £3½ billion. Both income tax and VAT have been particularly buoyant.
In the Budget, I set a public sector debt repayment—or PSDR—for 1988–89 of £3 billion, equivalent to around ¾ per cent. of GDP. With higher than expected Government revenues and lower than expected public expenditure, this year's PSDR now looks likely to turn out at some £10 billion, equivalent to over 2 per cent. of GDP.
This will be the second successive year of debt repayment, something that has not hitherto been achieved since records began in the early 1950s. Moreover, this year, the Budget would still be in surplus, by some £4 billion, even if there had been no privatisation proceeds at all. No other major economy has such sound public finances.
Looking ahead to 1989, the economy is forecast to grow by a further 3 per cent., with domestic demand also up by


3 per cent. Once again, investment is expected to grow considerably faster than consumption, and once again unemployment is expected to fall.
The slower growth forecast for 1989 inevitably implies a marked deceleration during the course of the year, particularly so far as domestic demand is concerned. Thus, comparing the second half of next year with the second half of this year, overall growth is forecast at 2½ per cent., and growth in domestic demand at only 1½ per cent.
The current account deficit is likely to fall only slightly, to some £11 billion, or 2¼ per cent. of GDP.
Inflation, while it will inevitably continue to edge up for some months to come, is forecast to peak at some point in the middle of next year before falling back again to 5 per cent. by the fourth quarter.
In short, after two years of unexpectedly rapid expansion, growth next year is forecast to return to a sustainable level, and one which compares well with the economic performance of the 1970s, while inflation will resume its downward path.
The public finances are in substantial surplus and will remain so, with public spending on priority programmes continuing to increase, while overall public spending continues to fall as a share of GDP, to a level in 1991–92 not seen for a quarter of a century.
The prospect that lies before us is yet further testimony to the success of the policies we have been pursuing these past nine and a half years and will continue to pursue, and to the economic transformation that those policies have wrought.

Mr. Gordon Brown: With the Chancellor's admission just before he sat down that inflation will rise beyond 6 per cent. by Christmas and that the balance of payments deficit will be an unparalleled £13 billion by the end of the year, will the Chancellor concede that the economic prospects that he promised us in the spring were not the economic realities of high interest rates, high deficits and higher inflation that we face in the autumn?
With imports rising this year by an astonishing 12 per cent. but exports by only 1·5 per cent., with our trade deficit of £2·5 billion now quadrupled for each of the next two years and with the deteriorating trade gap that is the Government's distinctive trade mark, will the Chancellor confirm that the trade deficit that he defends is almost as big a share of our national income as was the American deficit that he once so deplored?
Will the Chancellor confirm that inflation is running at almost twice the level of January, that it is more than twice as high as in our competitor countries—France, West Germany and Japan—that Britain will have the highest inflation rate of our competitor countries in 1988 and well into 1989, and that, far from being a temporary blip, 1989 will be the fifth year in a row when inflation will be above the European average? Does the Chancellor recall his objective, set out in 1984 and 1987, of zero inflation? Does he think that that promise is still credible when, after five Budgets and six Autumn Statements, inflation is now higher than when he became Chancellor?
Last November, when inflation was 4 per cent. and falling, the Chancellor told us that the minimum figure for public spending for next year would be £167 billion. After adjusting for the extra inflation that the Chancellor has

caused, that figure should be £172 billion. Now that the Chancellor tells us that he will provide only £167 billion and that there is therefore a shortfall in real terms of £5 billion, will he confirm that by failing to compensate for inflation there will be a real deterioration in our essential public services and that over the next year this Chancellor will preside over cuts in housing, essential services, investment and the environment?
Opposition Members welcome any additional resources for the National Health Service and any plan to break down the appallingly high waiting lists. However, is it not the case that the nurses' and doctors' pay rise will cost almost £1 billion in 1989 and that inflation adds another £1 billion to the Treasury's own figures? When health costs are rising faster than even ordinary inflation, the sum that the Chancellor has provided today will barely cover the basic inflationary pressures that the health authorities face, far less deal with their huge backlog of structural repairs. I ask the Chancellor to confirm specifically that even after his announcement today we will still be spending, throughout 1989, a smaller share of our national income on health than almost all our major competitors.
Is there anything more revealing of the Government's priorities than the fact that in the month when the Chancellor went to the Conservative party conference to affirm a new round of top rate tax cuts for those who are already rich he still refuses to find even the tiny amount that would save free eyesight tests and free dental check-ups, even for pensioners?
This is the first financial statement since the Prime Minister announced that she was converted to the cause of the environment. However, it is clear from today's figures, which show a cut in spending on the environment, that the Prime Minister has not converted the Chancellor. Will the Chancellor confirm that there will be not just cuts in spending on the environment, but huge reductions in housing investment, which will be virtually halved over two years, which will mean that thousands of young couples will have to keep on waiting for their first home?
Will the Chancellor also confirm the cuts in educational investment which will widen the training gap between Britain and our competitors at a cost of economic efficiency and our future prospects?
When, last week, Ministers awarded a 5·9 per cent. increase for pensioners and only a 4·7 per cent. increase for families on income support, did they know that they would have to come to the House this week to announce that inflation was above 6 per cent., and still rising, and that therefore the standard of living of millions of our citizens would inevitably fall? Is it not obvious for everyone to see that in this, as in so many other areas, the top rate tax cuts that the Chancellor gave to a few individuals in the spring are now being paid for by reductions in public investment for all our communities this autumn?
This is an Autumn Statement which compounds rather than corrects the errors of the Budget. It is an Autumn Statement which condemns an already congested Britain to further deteriorations in our public services. It is an Autumn Statement which, by the neglect of investment and a policy of high interest rates, leaves the British economy ill equipped and ill prepared for the challenges of the 1990s.

Mr. Lawson: It is apparent, I think, to the whole House that the hon. Gentleman had carefully written all that out before he had seen or heard the statement that I have made. Let me reply to the various points he made.
The hon. Gentleman said that next year, in 1989–90, there would be a real deterioration in public services. That is what he said. It is nonsense. If he looks at the figures, spending on programmes next year is due to rise by 2¾ per cent. in real terms. That is the truth of the matter.
Secondly, as far as the Health Service is concerned, the hon. Gentleman failed to listen to what I told him—and I explained carefully how this was arrived at. Real resources for the National Health Service next year will be 4½ per cent. higher than this year, far and away more than anybody has ever hitherto suggested. And I may say, spending on health as a proportion of total public spending is far higher today than it ever was under Labour.
As for housing investment, the hon. Gentleman alleged that there would be cuts in housing investment. That again is totally untrue. What he is talking about, of course, is the right-to-buy programme, but gross housing investment by local authorities and new towns will be up in real terms as well as in money terms. He said public investment will be down. In fact, public investment will be up by £2¼ billion. It was the Labour Government—the last Labour Government—who slashed public sector investment and we have maintained it and, indeed, outside the housing sector, it has increased under us.
The hon. Gentleman also called for more investment. As I pointed out to the House in my statement, over the past five years, total investment in this country has risen almost twice as much as total consumption. Indeed, taking the whole of our period of office since 1979, investment has risen more than consumption. Under Labour—they had admittedly a much smaller increase in consumption—the increase in investment was infinitesimal, only about one eighth of the increase in consumption. That is what happened when they were in office. Indeed, the hon. Gentleman's account of the economy showed again that he has no contact whatever with reality.
The hon. Gentleman talked about inflation. I am not going to take any lessons on inflation from the hon. Members opposite, when inflation, when they were in office, averaged 15½ per cent. and never once—not in one month, not in their most favourable month—was it ever as low as it is at the present time, even though it is still too high and it has to come lower; nor did he mention once record exports, record productivity, record investment, record output and record employment, too. I would have liked to have heard some acknowledgment of that from the hon. Gentleman.

Mr. A. J. Beith: I am grateful for the additional funds that the Government have provided for the National Health Service, but am concerned that the Chancellor is taking more money out of housing through local authority council house sales revenues than he is, on his own admission, putting back into it. Is he not singing, "Don't worry, be happy", when he is presiding over a high-risk strategy with interest rates which will remain high and feed through into mortgages and pay claims, with inflation which could touch 8 per cent. even within the forecast that he has given, with a balance of payments deficit which will not go down significantly so far as the eye can see, with the risk of a

sterling crisis and with the money supply not within the target range? Is itnot obvious that, instead of merely introducing an autumn statement, he should have brought forward an autumn Budget at the same time or, at the very least, indicated that he would not make further tax reductions in his next Budget, or does he not expect to introduce another Budget?

Mr. Lawson: I am grateful to the hon. Gentleman for letting me know about the difficulties of conducting economic policy. I have to tell him that I was already well aware of them and am already satisfied that the policies that we have in place are adequate to the situation, as, indeed, they have been for the past nine and a half years. There is no question of an autumn Budget, I can tell the hon. Gentleman. That only happened under the Labour Government which he supported.

Sir William Clark: The House will agree that my right hon. Friend would be well advised to ignore the carping criticism of the Opposition, particularly with their record of the management—or mismanagement—of our economy when they were in office. Does he agree that his statement will be welcomed, not only in this House, but in the country? I hope that he will emphasise the fact that the Government are unique in that they have cut taxation, increased public expenditure in real terms and have been repaying the national debt. Those are three very good things.
I am sure that the House will wish to congratulate my right hon. Friend the Chief Secretary to the Treasury on the admirable way in which he has dealt with the £167 billion. It will be welcomed that the percentage of national income going on public expenditure is now below 40 per cent. and is going lower. It is an achievement to have stuck to the £167 billion and he deserves our congratulations.

Mr. Lawson: I agree with everything that my hon. Friend said and, in particular, with his congratulations to my right hon. Friend the Chief Secretary. Of course, I have to confess to the House—I did not expect my statement to be welcome to the Benches opposite. I did not expect them to welcome the fact that we have succeeded in holding the planning total at £167 billion. I did not expect them to welcome the fact that we have got total public expenditure below 40 per cent. of GDP for the first time in over 20 years because, of course, the only thing they know about is increasing public expenditure, increasing it faster and faster, and faster than the economy can afford, and we know where that led to. It led to the humiliation of having to go cap in hand to the IMF, and they have learnt nothing from their experience last time.

Mr. Bruce Grocott: Is the Chancellor aware that, by his performance today, he has confirmed the Prime Minister's assessment that he is not leadership material? Is he also aware, in the light of his confident statement, that last Thursday the Shropshire health authority confirmed a large hospital closure programme for want of £3 million? If he is now putting his money where his mouth is, will he please write to the Shropshire health authority, telling it that it is no longer necessary for it to undergo those cuts because he is in fact proposing a real increase in income?

Mr. Lawson: As the hon. Gentleman knows—even though he has had to switch constituencies, I think he is probably now reasonably familiar with his new one—


unlike the slashing cuts in hospital spending under the Government that he supported, there have been substantial increases in hospital building programmes under this Government, not least the large new general hospital at Telford.

Mr. Terence L. Higgins: I welcome an autumn statement which shows that it is possible to combine the tax cuts of the last Budget with substantial increases in public expenditure and a far greater repayment of the public debt than anyone expected at the time of the last Budget.
Clearly, a growth rate of 4·5 per cent., which was also higher than predicted, is not sustainable. Is it now my right hon. Friend's intention to keep the growth in demand in line with the productive potential now being achieved?

Mr. Lawson: I am grateful to my right hon. Friend. Yes, indeed, it is necessary that we should keep the growth in demand in line with productive potential, and the growth in productive potential, fortunately, is the success of the supply side policies of this Government. The growth in productive potential now is greater than we have ever known in the past, but, of course, it is not as large as 44½ per cent. and there has to be a slowing down. That is right.

Dr. David Owen: I ask the Chancellor of the Exchequer to be more specific. In the economic prospects for 1989, he forecasts that there will be a slightly smaller current account deficit than £13 billion. Will he put a figure on that? Is it £12 billion or £11 billion? He goes into the question of a 5 per cent. inflation rate in the fourth quarter of 1989 and warns that it will peak in mid-1989. Is he talking of an 8 per cent. rise in the second or third quarter? The Chancellor also forecasts that unit labour costs will grow more rapidly than 1 per cent. over this year. What figure is he estimating for unit labour costs?

Mr. Lawson: On the last point, I do not have in my head the figure for the expected increase in unit labour costs, but the right hon. Gentleman will be able to find that in the material that is published today. It is, of course, only a forecast, and has the same status as other forecasts made by anybody. As regards the current account of the balance of payments, I did quote the figure that is being forecast for the current account deficit next year. It is a deficit of £11 billion. I am not surprised that the right hon. Gentleman did not hear it because of the barrage of noise that was coming from the Opposition Benches, which is such a deplorable feature of the House of Commons these days.

Mr. Leon Brittan: May I join in congratulating my right hon. Friend the Chancellor of the Exchequer on his formidable achievement in continuing the downward path of public expenditure as a proportion of national income while at the same time providing extra resources for priority areas of expenditure? Does he agree that if top priority is to be given to reducing the present levels of inflation, fiscal policy must reinforce monetary policy? That means envisaging an even higher level of debt repayment in the coming year than would otherwise be necessary.

Mr. Lawson: My right hon. and learned Friend obviously speaks with the particular authority of a former Chief Secretary to the Treasury, and I take note of what he says. The fiscal policy—the fiscal stance that we have now in the United Kingdom—is exceptionally tight, and looking at the fiscal stance one has to look at both sides, taxation and public expenditure, and, indeed, at the surplus, which is the difference between those two. As for the question of the Budget judgment, my right hon. and learned Friend will understand that I am not going to be tempted on to that ground now. The Budget judgment is something that I will take at the appropriate time in the normal way.

Mr. Jack Ashley: Will the Chancellor of the Exchequer please take note of the fact that yesterday I received a letter from a man who is paralysed from the neck down—a tetraplegic. He said that, as a result of the Government's cost-cutting social security changes in April, he is £13 a week worse off despite transitional protection. Will the right hon. Gentleman write to this man and thank him for contributing to his pot of gold in the form of a budgetary surplus? Will he console him with an assurance that, despite the appalling fall in his income, the British economy is bigger, stronger, more successful and so on?

Mr. Lawson: Well, of course, I do not know about the particular circumstances of the individual case that the right hon. Gentleman spoke about. What I do know is that spending on the disabled has increased by 90 per cent. since this Government took office, and there is provision for a further substantial increase in spending on the disabled in the public expenditure plans which I have published today.

Mr. John Townend: May I congratulate my right hon. Friend and his Treasury colleagues on withstanding the blandishments of some of their high-spending colleagues and keeping the planning total down to the level that was published last January? Does my right hon. Friend agree that repayment of the national debt, much of which was incurred by the profligacy of the last Labour Government, brings continuous benefit to our children and grandchildren? What is his long-term target for reducing public expenditure in terms of gross domestic product? Will it be reduced to the level of the 1960s, when we had another successful Conservative Government?

Mr. Lawson: My hon. Friend is right about the enormous value in having a Budget surplus and repaying the national debt year by year. There is the benefit in the short term that we see—being able to spend more on public expenditure programmes because debt interest is taking a smaller amount of the total public expenditure cake. It also, of course, is very important for future generations—reducing the burden of debt interest that future generations have to bear. It was the Labour Government who were entirely, if I may coin a phrase, a "me now" Government.

Mr. Dafydd Wigley: The Chancellor of the Exchequer partly attributed the increase in inflation to the increase in interest rates and the effect on mortgages. Does not he realise that eight of the 10 large building societies are not increasing mortgage payments until April 1989? That means that a political and economic time bomb will hit inflation in April, May and June 1989, just in time


for the European elections. Will he reconsider the use of interest rates as a short-term lever, and will he tell the House what his assumptions on interest rates are for the next two years?

Mr. Lawson: The hon. Gentleman is under a misapprehension about what he calls the political and economic time bomb. The way the RPI is constructed, the increase in mortgage rates is fed into the RPI immediately the building societies announce it. It does not wait until they implement it. Therefore, there is nothing further to come in April. It does mean, of course, that because one or two building societies, notably the Halifax, do not in fact require the people it is lending to to pay more until April —some of them do it much earlier and, of course, for new mortgages it is earlier—the tightening in monetary conditions that occurs as a result of putting up interest rates, and mortgage rates going up, is not something that happens instantaneously. It happens progressively, and there will be a progressive tightening for the very reason that the hon. Gentleman said, but the effect on the RPI is immediate.

Mr. John Watts: Does my right hon. Friend the Chancellor of the Exchequer recall that when he made his Autumn Statement last year there was well-founded apprehension that the crash in world stock markets would have a damaging effect on the British economy and the world economy generally? Will he accept that today's statement is a great tribute to the underlying strength of the British economy and to the timely measures that he took to ensure that the effects of the crash did not have a damaging effect on the British economy? Only the churlish would use hindsight to say that he was wrong in taking those steps in terms of ensuring adequate liquidity, or would criticise the measures that he has now taken to tighten monetary conditions so as to squeeze inflation out of the system.

Mr. Lawson: My hon. Friend is right. I do vividly recall the very different circumstances in which I introduced last year's Autumn Statement. I believe that the measures that we took to avert a world recession at that time were fully justified, even though, as I have said on another occasion, they may have stored up some problems later on. What I do recall is that the Labour party was urging me to cut interest rates far more and to expand far more than I thought it prudent to do at the time. I also recall more recently, incidentally, in our Budget debate that the hon. Member for Dunfermline, East (Mr. Brown) said:
current taxation revenues without privatisation receipts should exceed current expenditure, he did not balance the Budget last year or this year, and he will not balance it in years to come."—[Official Report, 21 March 1988; Vol. 130, c. 103.]
I hope that he will now concede that that is precisely what I have done.

Mr. David Blunkett: Will the Chancellor of the Exchequer confirm that the base from which his announcements on the Health Service funding were predicted was £25·683 billion? That has been increased already by the announcements made over recent months to £26·571 billion. Contrary to what the right hon. Gentleman said to my hon. Friend the Member for Dunfermline, East (Mr. Brown), this means that, taking into account the Government's optimistic prediction of 4·7 per cent. inflation and the dubious statistics on once-off sales of land and superannuation changes, the

Government will be short of £200 million in meeting the 4·7 per cent. increase in inflation for the Health Service. If this is not a sleight of hand, it has to be misleading and mischievous given the impact that it will have on those working in the Health Service and on those who receive the services that are provided by it. Will the right hon. Gentleman confirm that there has been a decrease, not an increase?

Mr. Lawson: I confirm no such thing. For example, it is absurd to suggest that the £300 million a year superannuation contribution—which NHS employers used to have to pay and will no longer have to pay and therefore the money will go straight into providing health care—should not be counted. That is an absurdity. That is £300 million of extra money. As I said, even after taking into account inflation, the real increase in health spending next year is around 4½ per cent.

Mr. Jeremy Hanley: Does my right hon. Friend agree that his reduction in income tax rates have helped to fuel extra taxation revenues and that the highest rate taxpayers now pay a larger proportion of those revenues than they did under a Labour Government? Will he also agree that, with the extra 3 per cent. above inflation for future spending programmes, the Conservative party has more humanity, more justice and more ability than the Labour party ever possessed?

Mr. Lawson: Certainly the Conservative party in government has a great deal more success in achieving economic growth as well as getting inflation down, therefore enabling more resources to be put to the purposes which I understood the Labour party was in favour of. Of course, the Labour party is totally oblivious to the facts and, after five and a half years as Chancellor of the Exchequer, I am beginning to believe that it is extraordinarily difficult to educate Labour Members.

Mr. Stuart Bell: While it may be true that the British economy weathered the stock market crash in the autumn of 1987, it has weathered less well the chaotic and catastrophic handling of the exchange rate and the tax reductions for higher earners introduced in the Chancellor's Budget this year. Will the Chancellor confirm that he is relying on the speculative movement of capital into this country to finance the deficit in our balance of payments which is now four times what it was forecast to be in last year's Autumn Statement? If that balance of payments deficit is to continue into the 1990s, how will it affect public, national and international confidence in our economy? If interest rates are to be the only barricade against the loss of confidence, how high will they have to go to maintain that international confidence?

Mr. Lawson: Clearly, so long as there is a deficit on the current account of the balance of payments, there must equally be an inflow of capital from overseas because the balance of payments must balance. Some of that inflow capital will be money that is lent and is securing interest. Some of it will be direct equity investment in this country. There will be and there are both kinds. More and more mobile funds today are looking for a good home and for a home where they have confidence in the political stability and economic policies of the Government concerned. That is why there is so much capital actively seeking a home in this country. The deficit on the current account of the balance of payments will in due course diminish quite


significantly, but in the meantime, as the markets show very clearly, there is complete confidence in this country and no problem whatever in financing the deficit that we have.

Mr. Ivor Stanbrook: While dealing with the many large and justified claims on the public purse, was my right hon. Friend this year able to accommodate a small one, and remove the injustice suffered by colonial service pensioners who are not allowed to count war service in their pension entitlement?

Mr. Lawson: I certainly recognise the very determined work of my hon. Friend and some others in lobbying for this. I am pleased to be able to tell them that provision has been made for war service credit in the calculation of pensions of ex-colonial service men. Up to 6,000 pensioners should benefit from that.

Mr. Giles Radice: When does the right hon. Gentleman expect the balance of payments to come back into surplus?

Mr. Lawson: Fortunately, under the Industry Act 1975 I am not required to forecast any further than the year ahead. It will not come back into surplus in 1989.

Mr. Quentin Davies: I know that my right hon. Friend is a very kindly and sympathetic man. His statement sets out the most magnificent record of economic management and very reassuring prospects for our economy. Will he spare a thought for the appalling problems that he has caused the Opposition? It is quite impossible to argue with such a record and say anything remotely sensible, as was demonstrated from the Opposition Front Bench. The prospect of £10 billion of public sector debt repayment next year is splendid, but its effect on demand will be negated if it is compensated by net household dissaving. I know that my right hon. Friend is concerned about this and that is why he has raised interest rates. Will he give us some estimate of how he sees the savings ratio moving over the next 12 months?

Mr. Lawson: My hon. Friend is clearly a most perceptive observer of the political scene. It is essential that there should be an increase in the savings ratio and that is why I increased interest rates quite substantially which will both deter borrowing and increase the incentive to save. It will incidentally provide an enhanced income for savers among whom, in particular, pensioners tend to be numbered. That is something which the Opposition have failed to acknowledge at any time during our debates. As for when the savings ratio will turn, that is one of the hardest things to forecast, but I expect that it will not be too long before we can see a turn up in the savings ratio.

Ms. Marjorie Mowlam: The Chancellor told us today that the RPI increase will be about 5 per cent. in the fourth quarter assuming that mortgage interest payments are excluded. If they are included in that equation, will pensioners receive a 5·9 per cent. increase or less?

Mr. Lawson: As I have said, RPI in the fourth quarter is likely to turn out at 6¼ per cent. Under this Government pensioners have had an uprating every year and will continue to have that, according to inflation in the

previous years. They will not, as occurred under the last Labour Government, be cheated by the switch from the historic basis for uprating to uprating on the basis of some spurious forecasts.

Sir Trevor Skeet: I congratulate my right hon. Friend the Chancellor of the Exchequer on granting an additional £120 million for basic research in the United Kingdom. That will be a tonic to British science and we hope that he will bear it in mind in future contributions. How much of this money will be applied to our international commitments in CERN and in space?

Mr. Lawson: I know my hon. Friend's long-standing interest in this and a number of other scientific and energy matters. I am afraid that I cannot answer his question, but I am sure that if he puts his question to the Minister responsible for these matters he will receive an answer.

Mr. Ron Brown: I congratulate the Chancellor on a wonderful statement and speech but may I tell him—[Interruption.] The figures surely represent lies, damn lies and Tory propaganda. If he does not understand that, there is something wrong. The reality is all around us. There is a major crisis in the economy and that will not be resolved simply by juggling the figures or by the Chancellor making pretty statements here.
The Chancellor has not mentioned Scotland. We appreciate in Scotland that there is a struggle going on against the poll tax, a very regressive tax which obviously benefits the rich at the expense of the poor. Will he not appreciate that, unless that tax is removed or controlled in some way, there will be a major challenge next year? The Chancellor must understand that increasingly more and more Labour Members will be backing the struggle even if that is against the law. It is the Government's law, an unjust law and a class law.

Mr. Lawson: This particular occasion is one on which we talk about public expenditure. Therefore, I shall content myself with informing the hon. Gentleman that public expenditure per head in Scotland is far far higher than public expenditure per head in England or Wales.

Mr. Tim Smith: Does my right hon. Friend agree that it is now clear that the British economy is heading not for the crash landing for which the Opposition are so desperately hoping, but for what economists are apparently wont to call a soft landing? Is not the remarkable thing about that so-called soft landing that it involves a growth rate next year of 2·5 per cent., which is extremely respectable by both international and historic standards?

Mr. Lawson: My hon. Friend is right in what he says about the Opposition. It is a matter for considerable concern that the Opposition should all the time be hoping and wishing to see economic disaster. What is causing such frustration on the Opposition Benches is that year after year since they have been in opposition they have predicted it, and year after year it has failed to turn up and it will continue to fail to turn up.

Mr. Dick Douglas: Will the Chancellor give us some insight into certain aspects of the international economy, particularly the movements in the price of oil, which vitally affect his tax-raising powers? Secondly, if a growth rate of 4·5 per cent. is not sustainable, due to certain elements of overheating which


particularly affect the midlands and the south-east, and we are reduced to a growth rate of 2·5 per cent., which leaves Scotland with high and unacceptable levels of unemployment, how will his policy correct the disastrous regional imbalances which persist in the United Kingdom?

Mr. Lawson: On the first part of the hon. Gentleman's question, the British economy's dependence on oil and oil tax revenues was never nearly as great as many people imagined. Indeed, since the collapse in the oil price in 1986, the importance of oil tax revenues to the Exchequer's total revenues is really very slight indeed. Therefore, the hon. Gentleman need lose no sleep over that. What I think we would obviously most like to see is the absence of a high degree of volatility in the oil price because that makes it rather harder for the oil companies to plan their investment programmes. As for regional imbalances, the Scotish economy is doing better now than it has ever done before. As the hon. Gentleman knows, continuation of that improvement is overwhelmingly in the hands of the Scottish people themselves.

Ms. Joyce Quin: Has the Chancellor any idea of what the regional breakdown in the expenditure that he has announced will be? For example, in the inadequate amount of public sector capital investment that he has announced, will there be any guarantee that the regions will get the direct links to the Channel tunnel that they badly need?

Mr. Lawson: My right hon. Friend the Secretary of State for Transport has received a particularly large percentage increase in his programme. A substantial amount of extra money will be spent on roads, but how that is allocated between different road projects is, to a considerable extent, a matter for him.

Mr. Nicholas Budgen: Is it not disturbing that even in the third quarter of this year the clearing banks lent a record £5 billion on mortgages? Does that not clearly show the extent of the overheating in the economy and how long and hard it will be to contain inflation?

Mr. Lawson: The battle against inflation is one that has to be waged all the time and is always a struggle, but I think that my hon. Friend should realise that what has been happening lately is that the banks have been securing an increased share of the market at the expense of the building societies and in looking at the mortgage market it is necessary to look at the banks and the building societies together, not just one part of the whole market. It is fairly clear—most people who are close to the housing market are aware of this—that the housing market has softened considerably since the summer of this year.

Mr. Anthony Beaumont-Dark: Will my right hon. Friend accept that these figures are truly remarkable and better than many of us expected the outturn to be, and that many of us are extraordinarily pleased about the extra money being given to the overseas aid programme, particularly bearing in mind the tragedies that have happened in the past 12 months? Do the National Health figures, which are much more than the leaked figures that we all heard yesterday, mean that Her Majesty's Government will encourage the Department of Health to spend more on preventive medicine, and will that help the outcome of tonight's debate?

Mr. Lawson: I am grateful to my hon. Friend for his earlier remarks. Priorities within the health programme are, in the first instance, a matter for my right hon. Friend the Secretary of State. The whole question of improving further the NHS is very much at the heart of the review of the Health Service and health care that we are conducting under the chairmanship of my right hon. Friend the Prime Minister.
As for the outcome of tonight's debate, I very much hope that the measures that the Government are proposing, which are desirable and right on their merits, will be approved by the House. But I have to make it clear that if, by any mischance, that were not to be the case, there would be no question of additional funds being made available for the NHS over and above the massive increases that I announced earlier today.

Several Hon. Members: rose—

Mr. Speaker: Order. I must have regard to the subsequent debates that the Chancellor has just mentioned, and we also have a ten-minute Bill today. I shall allow questions on this important statement to continue for another 10 minutes and then we must move on.

Mr. David Winnick: Is the Chancellor proud of the fact that since the Government have been in office there have been cuts in housing public expenditure of nearly 70 per cent. which have resulted in a great deal of housing misery and which could be seen by the Chancellor in a five-minute walk from Downing street to the Embankment? Does not he recognise that so many of those people in housing need cannot afford a mortgage and certainly cannot afford the market rents that will arise from what is now being proposed in the Housing Bill? If all is so well in the economy, why does the Prime Minister take the view that the Chancellor is not the person to succeed her? Is he not at times humiliated by the way that he is treated?

Mr. Lawson: The Government's housing policy has two main planks. One is to switch resources from the public to the private sector, and that we have done with enormous success by private sector housebuilding increasing very substantially and, of course, by the right-to-buy programme—the purchase by council tenants of their own homes. The other element which has come to the fore more recently is the resuscitation of the private rented sector. That again is of the first importance and that was why the new business expansion scheme arrangements were put in place in this year's Budget and they are again proving extremely successful.

Mr. David Curry: My right hon. Friend correctly identifies the preoccupation with inflation. Therefore, does he agree that it is doubly important that the Opposition should not egg on every wage claim for the next 12 months? Further, will he make it clear to industry that it cannot count upon a progressive deterioration of the exchange rate to compensate for any failure to control industrial costs?

Mr. Lawson: I underline that. I believe that that is a point I have made on a number of occasions over the past two years. I happily reiterate it now. It is, after all, of the first importance that businesses have to control their own


costs in order to remain competitive, and that means controlling their own wage costs. They will not be bailed out by a devaluation of the currency.

Mr. Nigel Griffiths: Does the Chancellor of the Exchequer accept that the Autumn Statement shows high interest rates and a high pound, which have inflicted so much damage on manufacturing and commerce, and does he also accept that, having inflicted damage on our public services, the future is bleak? If not, what is the future?

Mr. Lawson: I know what the future would be if there were ever to be a Labour Government, which there will not be, based on the recipe which the hon. Member for Edinburgh, South (Mr. Griffiths) has put forward. It would be certainly a much lower pound, lower interest rates in the short term but then having to rocket up later, an economic crisis, and raging inflation. That is what we would see if the policies which the hon. Gentleman is advocating were pursued.

Mr. Michael Jack: I hope that my right hon. Friend accepts the fact that the views of the Opposition are blinkered. There has, as a result of my right hon. Friend's economic policies, been massive private sector investment in north-west England, to the benefit of all concerned.
I wish to ask my right hon. Friend about National Savings—another product of the north-west. In the light of his excellent tax revenues, I seek his assurance that National Savings products will continue to be developed, to assist savings.

Mr. Lawson: I appreciate my hon. Friend's continued interest in the National Savings department. Indeed, it will have a continuing role to play. He will recall that I announced at the Conservative party conference in October of this year that we will be launching in January an entirely new National Savings instrument, the capital bond, which I hope will prove to be extremely attractive.

Mr. A. E. P. Duffy: The Chancellor of the Exchequer made no mention of interest rates—his sole regulator—or of monetary growth, which is truly alarming. Given his deteriorating balance of payments deficit, is it not certain that one crucial question that should be asked of his statement is how soon it will propel him into yet another round of interest rate rises? What assurance can the right hon. Gentleman give the House, in view of today's reinforcement of domestic demand, sustained monetary growth, and the world trend towards interest rate rises?

Mr. Lawson: I am always particularly interested in what the hon. Member for Sheffield, Attercliffe (Mr. Duffy) has to say, not least because it is always in complete 180-degree contradiction to everything that his hon. Friends have to say. As I have always said, the level of interest rates will be whatever is necessary in order to keep downward pressure on inflation, and they will be kept at that level for as long as it is necessary to do so.

Mr. Phillip Oppenheim: Does my right hon. Friend accept that there is a huge gulf between his Autumn Statement and the series of mini-Budgets and almost monthly crises that studded the last Labour Government? Will he bear in mind that there are millions

of savers in this country as well as borrowers; that those savers need to be encouraged; that higher interest rates encourage saving and will improve the savings ratio—in marked contrast to the situation in the 1970s, when savers found their returns continually outpaced by inflation?

Mr. Lawson: My hon. Friend the Member for Amber Valley (Mr. Oppenheim) is absolutely right. It was the last Labour Government which robbed the savers, and the elderly in particular, by inflation—which not only gave them profound anxiety as to what their pension would buy next month, next week, whatever it happened to be, but also of course meant that they had a negative real return on the savings they had. Now the real return is positive. It has been positive for many years past, and it has now been increased. That is something which is very important to savers, and it is important at the present time to the health of the British economy.

Mr. Rhodri Morgan: The Chancellor has berated the Opposition for waiting for an economic disaster to happen. I put it to him that what really concerns us are two aspects of the Government's economic policy. First, unemployment is still twice what it was when the Government came to office. If there had been the supply side miracle to which the Chancellor has referred, that would not be the case after nine and a half years. Secondly, the Chancellor said that the cumulative balance of trade deficit for the fiscal years 1988, 1989 and 1990 will total well over £30 billion and possibly £35 billion, thereby taking up most of the £50 billion oil price cushion that has been built up in United Kingdom assets owned abroad. The Chancellor is surely really saying that he is waiting for a supply side miracle.

Mr. Lawson: The supply side miracle has already happened and we are seeing the benefits of that. As for unemployment, I will tell the hon. Member for Cardiff, West (Mr. Morgan) that there are more people at work in this country today than ever before in our history.

Mr. Conal Gregory: I congratulate my right hon. Friend on his admirable statement. Bearing in mind that the personal ratio of debt to assets has increased to about 33 per cent. and that the principal instrument that he is using is interest rates, will he give consideration to the possibility of controlling personal finance through, for example, urging the credit card companies to increase the minimum return on a monthly basis and by controlling hire purchase? The National Association of Citizens Advice Bureaux says that almost 1·4 million people approached its offices last year with debt problems. With that in mind, will my right hon. Friend give urgent consideration to the other mechanisms that I have mentioned?

Mr. Lawson: I do not think that what my hon. Friend the Member for York (Mr. Gregory) says would really help in the present situation—not least because personal borrowing and household borrowing is overwhelmingly borrowing on mortgages. Both credit cards and hire purchase are a very, very small proportion of the total—it is overwhelmingly borrowing on mortgages. No, there is no escape from the need to raise interest rates, and that is why I have raised them and will continue to keep them as high as they need to be for as long as is necessary.
As for what my hon. Friend says, however, that does not mean that there is not a responsibility—there is—on


both lenders and borrowers: for lenders not to lend to those whom they think might get into difficulties, and for borrowers not to borrow beyond their capacity to repay and to service.

STATUTORY INSTRUMENTS, &c.

Mr. Speaker: By leave of the House, I shall put together the Questions on the five motions relating to statutory instruments.

Ordered.
That the Food Protection (Emergency Prohibitions) Amendment No. 4 Order 1988 (S.I., 1988, No. 1881) be referred to a Standing Committee on Statutory Instruments, &amp;c.
That the draft Criminal Justice Act 1988 (Offensive Weapons) Order 1988 be referred to a Standing Committee on Statutory Instruments, &amp;c.
That the draft Weights and Measures (Miscellaneous Foods) Order 1988 be referred to a Standing Committee on Statutory Instruments, &amp;c.
That the draft Weights and Measures (Intoxicating Liquor) Order 1988 be referred to a Standing Committee on Statutory Instruments, &amp;c.
That the draft Education Support Grants (Amendment) (No. 2) Regulations 1988 be referred to a Standing Committee on Statutory Instruments, &amp;c.—[Mr. John M. Taylor.]

London Local Authorities Bill

Mr. Simon Hughes: On a point of order, Mr. Speaker. This point of order arises out of the first matter of this afternoon that you, Mr. Speaker, asked to be taken now, in relation to the London Local Authorities Bill, about which you may have been alerted.
I objected to the motion this afternoon and obviously the matter has been put back. This matter arises from the last occasion that the Bill came before the House. It was objected to on the first occasion, and on the second occasion my hon. Friend the Member for Ceredigion and Pembroke, North (Mr. Howells) objected to it as well—but I understand from inquiries I have made that that objection was not heard.
I wonder whether it is possible, on the grounds that I understand exist in "Erskine May", when a stage of a private Bill is taken by mistake, for the order that the Bill has been read a Second time to be discharged and the matter be remitted so that the Second Reading can again be put before the House and proceeded with as though the objection had been taken.

Mr. Speaker: I thank the hon. Member for Southwark and Bermondsey (Mr. Hughes) for giving me notice of his point of order.
Unfortunately, the events about which he is concerned took place as long ago as 20 October. If a right hon. or hon. Member objects to a stage of a Bill when it is called, it is up to him to make sure that his objection is heard by the Chair. If the occupant of the Chair proceeds to put the Question and subsequently declares that the Ayes have it, as I did on that occasion, then the right hon. or hon. Member wishing to object has missed his opportunity and there is nothing that can be done about it on a subsequent day. I regret that there is nothing that I can do to help in this matter.

Trade Descriptions Act 1968 (Amendment)

Mr. John Browne: I beg to move,
That leave be given to bring in a Bill to extend the Trade Descriptions Act 1968 to require the labelling of furs procured by means of the trapping of wild animals and for related purposes.
My aim is to make the potential British purchaser of furs at least aware that a fur has come from a trapped animal that has probably suffered a long drawn out and agonising death.
It will be remembered that earlier this year the Government introduced a similar amendment. Then, prior to the Toronto summit, which itself followed a debate on this issue in the Canadian Parliament in which some Canadian Members called for economic sanctions against our country, the Government dropped the proposed Bill because of legal technicalities.
One technicality was the legal definition of the term "commonly caught" by trapping. I have tried to overcome this technical difficulty in the drafting of the Bill.
Trapping is cruel, indiscriminate and unnecessary. It is not just cruel, but brutally cruel. It is bad enough for a man to be caught in a trap in the wild, but can you, Mr.


Speaker, or any right hon. and hon. Member imagine the mental trauma of a wild animal caught in a trap—the feeling of sheer terror, of wild panic and mental and physical agony? A trapped animal's first reaction is to bite and to fight the trap itself, which of course is made of metal, so it invariably breaks its teeth and even its jaw. When it gives up that fight against an inanimate object, it starts to pull and gnaw off its limb that is caught in the trap to try to break free.
If it is still alive after two, three, seven or even 10 days of absolute agony and mental desperation, weakened severely by lack of water and food, the animal is then killed by the trapper. It may, if it is lucky, be shot, but shooting spoils the fur. Shooting is relatively expensive. Shooting involves the trapper in a risk of ricochet—of hitting himself—when firing at a target at such close range, as the bullet may hit a stone. So most of the animals are either clubbed or suffocated to death.
Clubbing is a very drawn-out way of killing an animal, but suffocation is even more grotesque, judging by the instructions that are found in trapping magazines. One example is the instruction to lay the exhausted animal out with one foot on its open throat and the other on its rib cage, using what is described as a rocking motion, to drive the air out of the animal's lungs while letting air out but none in by means of the foot pressure on its throat. Gradually—gradually—the animal dies, in a space of time, depending on its health at the time, of between five and 15 minutes. It is a grotesque form of death. I have pictures of these various forms of death which I shall make available for right hon. and hon. Members in the Library.
Trapping is nothing more or less than obscene, brutal and drawn-out cruelty to animals. It is also entirely indiscriminate. It is impossible to target a trap. Birds of prey are caught; endangered species are caught; even hunting dogs or the pets of people wandering in the forest and the outback are caught.
What is more, trapping is actually unnecessary. Yet it is defended vociferously as vital to indigenous life in the outback. It is estimated that more than 20 million animals are killed by trapping each year in north America alone—there are no statistics for the Soviet Union—and that there are more than 500,000 registered trappers in north America alone. They constitute a very well-organised and powerful lobby.
Yet the estimates of what I term the "native" trappers—the trappers who genuinely hunt animals by trapping for their living—are relatively small. Native trappers really exist today only in the Yukon and the North-West Territories of Canada, and in those provinces they represent fewer than 5 per cent. of registered trappers. The native trapper is in a very small minority.
Evidence shows clearly that trapping is overwhelmingly a hobby—a grotesque hobby. So let us see what the British public think of it. In a major poll conducted in March 1987 by Research Surveys of Great Britain Ltd., the statement that there should be a ban on the import of all fur and fur products made from trapped animals attracted an overwhelming 72 per cent. support. The tougher statement that there should be a complete ban on trapping animals for their fur attracted 74 per cent. support. When the sample was taken just from women—the main beneficiaries of furs in this country—a staggering 83 per cent. supported the ban.
Let us see how that public opinion has been translated politically. In this Session of Parliament we have had two early-day motions, No. 978 in the name of my hon. Friend the Member for Bury St. Edmunds (Sir E. Griffiths), and No. 287 in the name of the hon. Member for Birmingham, Erdington (Mr. Corbett). Each of those early-day motions attracted about 200 signatories from the Back Benches, although the Government had dropped their proposed legislation.
I am proud to say that the British Government have made trapping illegal in the United Kingdom. I am also proud to say that the British Government have signed the Berne convention, and I am very pleased to hear that the EEC Commission strongly supports legislation such as that originally proposed by Her Majesty's Government and now proposed by me, along with my sponsors.
Public opinion in the civilised world demands action against trapping. My right hon. Friend the Secretary of State needs this Bill so that he can inform individual people and so allow each person to take his own individual actions within our country.
Of course the Bill treads on many rich and politically powerful toes, but I emphasise to you, Mr. Speaker, and to my right hon. Friends in Her Majesty's Government, that when the abolition of slavery was first proposed in this House it also met massive resistance from rich and politically powerful vested interests. Yet the Members of this House stood firm, and England led the world in abolishing slavery. It is in that spirit that I commend the Bill to the House.
Question put and agreed to.
Bill ordered to be brought in by Mr. John Browne, Mr. Harry Cohen, Sir John Farr, Mr. Tony Benn, Mr. Churchill, Mr. David Steel, Mr. Sydney Chapman, Mr. Charles Kennedy, Mrs. Elizabeth Peacock, Mr. Donald Anderson, Mr. John Hannam and Mr. Alan Beith.

TRADES DESCRIPTIONS ACT 1968 (AMENDMENT)

Mr. John Browne accordingly presented a Bill to extend the Trade Descriptions Act 1968 to require the labelling of furs procured by means of the trapping of wild animals and for related purposes: And the same was read the First time; and ordered to be read a Second time tomorrow and to be printed. [Bill 221.]

Orders of the Day — Health and Medicines Bill

Lords amendments considered.

Mr. Robin Maxwell-Hyslop: On a point of order, Mr. Speaker. I think it would be generally agreed that it is very difficult for hon. Members to relate what is actually happening to the various papers before them today. I do not expect you to reply to me substantially today, but my question is this. Does it lie within your power to order that the paper called "Consideration of Lords Amendments" be consolidated with the actual list of Lords amendments, so that we know what action is proposed by amendment in the case of each Lords amendment rather than having two different papers relating to the Bill? Or does it require a positive examination and report by the Procedure Committee before such action can be taken? I respectfully submit to you, Mr. Speaker, that the chaotic papers today give the best example there could ever be of the need for reform of this matter so that hon. Members actually know what they are doing.

Mr.Speaker: The hon. Gentleman is right. The House often feels that it is difficult to relate the amendments to the Lords amendments when they are on separate papers. I shall look into what the hon. Gentleman has said with a view to seeing if there is anything I can do in the matter. If I cannot do anything, the matter might be referred to the Select Committee on Procedure with a view to changing the practice. Today, however, as we proceed, the occupant of the Chair will make it as clear as possible what amendments we are debating and relate them to the Lords amendments.
The first Lords amendment falling for debate this afternoon is Lords amendment No. 1. I must inform the House that the amendment is affected by privilege. With this it will be convenient to discuss Lords amendments Nos. 2 to 4 and Lords amendments Nos. 36, 37 and 44.

Clause 1

VESTING OF PROPERTY ETC. OF CORPORATION IN A COMPANY NOMINATED BY THE SECRETARY OF STATE AND DISSOLUTION OF CORPORATION

Lords amendment: No. 1 in page 1, line 20, at end insert
or rights to subscribe for any such securities

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The Parliamentary Under-Secretary of State for Health (Mrs. Edwina Currie): I beg to move, That this House doth agree with the Lords in the said amendment.
I shall do my best to pick my way through the forest of amendments. I put on record our appreciation of the detailed revision work on the Bill carried out in the other place.
The first group of amendments refers to clause 1 which refers to the General Practice Finance Corporation. Clauses 1 to 6 provide for the abolition of the GPFC as presently constituted, and for its property, rights and

liabilities to be transferred to a company incorporated under the Companies Act 1985, which I shall call the successor company.
In reply to the question why we should do that, I would refer to the original context and role of the GPFC and how that has changed during the past 20 years. As independent contractors, general medical practitioners are responsible for providing surgery premises. Back in the 1960s some doctors found it difficult to raise the capital required so that GPFC was set up under the 1966 Act with powers to make long-term loans to doctors for the purposes of acquiring or improving practice premises. Those powers were extended by the Health Services Act 1980 to include the acquisition and leaseback of premises.
The lending scheme operated by the corporation allows loans up to 100 per cent. of the cost or valuation of surgeries over a term of up to 20 years at fixed or variable rates of interest. Before making a loan, the GPFC must be satisfied that the premises have been approved by the local family practitioner committee and will be used regularly and substantially for the provision of general medical services under the NHS.
The GPFC is a non-profit making and entirely self-supporting organisation. It charges all borrowers a rate of interest sufficient to cover its own borrowing and administrative costs. It obtains funds by temporary borrowing and by issuing stock under Treasury guarantee, all of which to date—£125 million—has been taken up by the National Investment and Loans Office. The GPFC's borrowing net of repayments to NILO is classified as public expenditure and as a result contributes to the PSBR, hence our interest in removing it from that consideration. We feel that such a financial service was thought necessary in 1966, but, given that such financing is a well-established private sector activity, we need to ask why we need to make special provision for it in the public sector in respect of family doctors. I believe that the answer is that we do not.
Plenty of GPs already raise funds for their practice premises from other financial institutions. On various occasions they have been proud to show off those premises to me, and there is no reason to believe that they would be less likely to use the GPFC if it were privately owned.
Funds are readily available and there is healthy competition among lenders. In such circumstances, it makes obvious sense to concentrate our public resources on those things which only the public sector can do. In transferring the corporation to private ownership, we shall be giving a major reputable financial institution the opportunity to acquire the GPFC. We shall not be giving it away; we shall acquire some money for it and we expect that institution to administer it in the interest of doctors and patients.
As well as commanding the confidence of private sector investors, we wish to retain the interest and involvement of our family doctors. To that end we are undertaking discussions with their representatives and with the corporation about how best that might be achieved. We certainly hope and expect to see family doctors on the board of the new company so that they can contribute their knowledge and experience to the management of its affairs. We are also seeking powers to influence the content of the memorandum and articles of association so as to safeguard the main objectives of the present corporation through the successor body. We are also increasing the corporation's current borrowing powers from £150 million


to £160 million to ensure that it remains actively in business pending the conclusion of the new arrangements that we propose.
The four amendments to clause 1 are important but essentially technical. They are designed to smooth the passage of the GPFC into the private sector. Amendments Nos 36 and 37 to clause 23 refer to the date when the GPFC clauses start to operate on Royal Assent.
I shall now turn to the individual amendments. Clause 1(3) enables the Secretary of State, with the consent of the Treasury, to acquire, hold and dispose of stocks, shares and other securities of the successor company. It does not refer to the rights to subscribe to securities. In other words, it does not cover rights issues. Lords amendment No. 1 seeks to ensure that it does so. It is precedented in section 52(1)(b) of the Gas Act 1986.
Clause 1(12) provides that any sums received under paragraphs (a) and (b) of it shall be paid into the consolidated fund. However, it may be necessary for the Secretary of State to discharge the liabilities either of the corporation or of the successor company and pay the balance into the consolidated fund.
Lords amendment No. 2 and Lords amendment No. 3, which is consequential upon 2, admit payments elsewhere. Lords amendment No. 4 is a technical amendment referring to a new schedule to the Bill which is Lords amendment No. 44. The purpose of the additional schedule to the Bill is twofold and I have no doubt that Opposition Members will welcome it. First, it ensures that any agreement made by the GPFC will have effect after vesting day as if made by the successor company. In particular, we wish to ensure that where the GPFC is a lessee subletting to doctors any covenant restricting assignment shall not prevent the substitution of the successor company as lessee in place of the GPFC.
Secondly, we wish to ensure that the transfer on vesting day will not operate so as to terminate the contract of any person employed in the GPFC and that the terms of the contract will not be varied in any way apart from substituting the successor company as the employer.

Ms. Harriet Harman: Good.

Mrs. Currie: The hon. Member for Peckham (Ms. Harman) says, "Good". It is nice to have some non-partisan support for what we are doing.
Both those objectives are secured by the amendment. I ask the House to support these technical amendments.

Mr. Ronnie Fearn: In subsection (2), consequential on (1), which was mentioned, will the Minister explain what the consolidated fund is at the moment?

Mrs. Currie: Will the hon. Gentleman extend his question so that I can give it the due care and consideration which it obviously requires? Will he explain to me at a little more length exactly what he is talking about?

Mr. Fearn: So that the Minister can get the answer in time, I shall explain. Subsection (2) enables the balance of a discharge of liability to be paid into the consolidated fund. Originally, all moneys were to go into that fund. I am not sure whether that is good or bad.

Mrs. Currie: I am very grateful to the hon. Gentleman for raising this most important point. As the Bill stands, clause 1(12) provides that any sums received by the Secretary of State under paragraphs (a) and (b) in connection with the reconstitution of the GPFC must be paid into the consolidated fund, which is, as I am sure the hon. Gentleman knows, the account into which all public money due to the Exchequer is usually paid. That is because it was envisaged that the GPFC's indebtedness to NILO would be repaid by the purchaser and not by the Secretary of State. The National Loans Act 1968 provides that all money raised by the creation of debt is payable into the national loans fund together with receipts representing repayments of loans made from the fund or, before that Act came into effect, charged directly on the consolidated fund, and interest on those loans. The national loans fund is the channel through which all the Government's borrowing transactions, and most domestic lending transactions, pass. It is still likely that the purchaser will repay the NILO debt directly, but there could be a premium payable for premature redemption which reflects the difference between the prevailing gilt redemption yields. I am sure that the hon. Gentleman is following carefully. That will be only on fixed rate stocks—variable rate stocks will, as I am sure the hon. Gentleman knows, be repaid at par value.
The Secretary of State might have to pay the premium from the proceeds of sale, and it would go to NILO. It is against such an eventuality that we are taking powers to enable him to pay moneys into other than the consolidated fund. It is necessary that he should be able to discharge liabilities either of the corporation or of the successor company and pay the balance into the fund. I hope that that has answered the hon. Gentleman's question.

Mr. Fearn: rose—

Mr. Deputy Speaker (Mr. Harold Walker): Order. The hon. Gentleman can speak only once in a debate on a Lords amendment.

Question put and agreed to. [Special entry.]

Lords amendments Nos. 2 to 4 agreed to. [Special entry.]

Clause 7

EXTENSION OF POWERS OF SECRETARY OF STATE FOR FINANCING THE HEALTH SERVICE

Lords amendment: No. 5, in page 5, line 18, leave out "powers" and insert
the powers specified in subsection (1A) below; but for the avoidance of doubt it is hereby declared that nothing in this section authorises him or any body to which he gives directions under subsection (1B) below to disregard any enactment or rule of law or to override any person's contractual or proprietary rights.(1A) The powers mentioned in subsection (1) above are powers—

Mrs. Currie: I beg to move, That this House doth agree with the Lords in the said amendment.

Mr. Deputy Speaker: With this it will be convenient to consider Lords amendments Nos. 6 to 8 and 10 to 17.

Mrs. Currie: Lords amendment No. 5 refers to clause 7, which is about income generation. It might be helpful if I were to give a summary of what we are trying to achieve in clause 7. I am sure that it will help the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) as the


amendment covers different parts of the clause and it is important that the hon. Gentleman understands exactly what this group of Lords amendments would do.
In general terms, the clause gives health authorities wider powers to generate income for improving the Health Service. That is what the preamble to the clause says. From debates about the clause since the Bill was introduced to the House almost one year ago, I sometimes wonder what some people have read into those words. The clause allows health authorities to charge at commercial rates in the case of private patients and overseas visitors. I remember that, when the hon. Member for Strathkelvin and Bearsden, who is now on the Opposition Front Bench, was a mere stripling of a Back Bencher, he called on us on Second Reading to do precisely what I have described. I cannot see that there is much for the Opposition to quarrel with, but they managed to spend a good few hours in Committee airing their arguments before eventually admitting how sensible the changes are.
The clause contains a strong safeguard to ensure that none of this new activity should be to the detriment of the NHS and its patients. Indeed, the purpose of the clause is to enhance the NHS, not to detract from it.
Existing legislation did not foresee health authorities wanting to use facilities other than for purposes directly concerned with the treatment of patients. I suspect that, by accident rather than by design, existing legislation can be read to permit authorities to pursue some income generation ideas, whereas others such as advertising, catering for outside bodies or running health clubs are clearly ultra vires. There is another group of activity about which the law is unclear. We have responded to the call from our own Health Service managers that we should clear up the matter. We agree that there is a clear need for legal provision which puts it beyond doubt that authorities can make full use of their facilities for income generation.
5.15 pm
The clause deals with three strands—income generation per se, private patient income and income from charges on overseas visitors. There is, however, a common theme—the provision of additional income for the Health Service. This is a good housekeeping measure intended to encourage health authorities to realise to the full the financial potential of resources at their disposal. It will provide health authorities with a valuable source of income while remaining no more than a marginal activity in the totality of Health Service funding. We have never claimed that income generation is any more than that. It never can account for more than a tiny fraction of total Health Service funding, and we have never suggested otherwise.
Clause 7(1) contains the meat of the income generation powers—the basic powers to acquire, produce and provide, for a charge, goods, land, accommodation and services, including training. It allows commercial exploitation of suitable Health Service innovations and developments. The powers were deliberately drawn wide, which I suspect is the reason for some of the fears that have been expressed at various stages of parliamentary consideration of the Bill, so that we would not be faced with the need to enact further legislation to permit activities which were inadvertently omitted from the Bill. The powers are permissive and are qualified by safeguards. They are not mandatory obligations. We shall not require all health authorities to set about manufacturing and

selling all manner of things indiscriminately. The final part of subsection (1) provides for the issue, by the Secretary of State, of directions to health authorities about the use of these new powers.
Clause 7(2) and (3) provide that the powers may be restricted by directions issued by the Secretary of State. We have already issued guidance on income generation to health authorities. More will follow if it is the House's will that the Bill should become law. We have no reason to suppose that health authorities will act irresponsibly in their use of these new powers.
Subsection (4) provides that the wide powers introduced in subsection (1) do not apply to provision for private patients. Such provision is dealt with in the original legislation and in clause 7(7) and (8), which ensure that the rather tighter conditions surrounding the provision of services for private patients shall apply, particularly with regard to the authorisation of pay beds, in respect of which we have retained central control.
Perhaps I may be permitted to go a little more deeply into the safeguards against the misuse of these powers as it was a matter of some concern in the other place and it has given rise to some of the amendments before us.
Subsection (5) stipulates that none of the powers provided by clause 7 shall interfere with the duty to provide services under the NHS, nor be used to the disadvantage of NHS patients. I am sure that the House agrees that that is important. Income generation is to be a marginal activity, and I hope that hon. Members will not propose the notion that we seek these powers to make the NHS a monolithic trading organisation. We are not doing that.
The Secretary of State's duty to provide a comprehensive Health Service is not affected in any way by clause 7, and subsection (5) makes that clear. Subsection (5) also limits the charging powers in subsection (1)(h) to non-NHS matters. That is important and worth dwelling on as Opposition Members argued, especially in Committee, that the clause would open the door to new charges for NHS treatment or services. That is simply not true.
Subsection (7) concerns private patients. We decided that health authorities should be permitted to set their pay bed charges to make a profit. The hon. Member for Strathkelvin and Bearsden felt that that was wise and sensible, so I believe that he will support us tonight. The number of authorised pay beds and their location will remain a matter for central approval. We believe that market forces should apply to the pricing of private treatment in NHS hospitals, and subsection (7) permits that by consolidating and simplifying previous legislation on private patients and enabling charges to be set on a commercial basis. The NHS should benefit considerably from that. As hon. Members will be aware, we did rather oversimplify some of the private patient provisions, as the British Medical Association and others on its behalf told us. The amendments which we brought forward in another place are intended to remedy that excess of zeal.

Mr. Maxwell-Hyslop: I have been following with great interest the excellent case which my hon. Friend has put up. In the private sector, it is possible to make arrangements whereby employees or managers who produce new ideas for generating revenue for the firm can have a percentage of the profits in the first year. It is right that the provisions which my hon. Friend recommends should enable the profits made to be kept by the Health


Service rather than go into the consolidated fund. Does this permit a local health authority, or the Minister, to make an arrangement whereby new ideas for income generation can benefit the NHS employee who suggests them?

Mrs. Currie: The key NHS employee in most district health authorities is the district general manager. Managers are now all on short-term contracts with performance-related pay.

Mr. Maxwell-Hyslop: The system could work all the way through.

Mrs. Currie: We would be interested in extending that proposition to other members of staff, but for the time being this applies only to senior managers. We would expect that an NHS manager who was able to generate in wise and sensible ways considerable income for his health authority would have that ability and success recognised when he was next reviewed. We would expect that, if an NHS manager were totally incapable of undertaking that kind of activity, that would be taken into account. I take my hon. Friend's point—many businesses have reward schemes. We would not want to pronounce on that matter from the Dispatch Box. We would want to leave it to the common sense of the local people. My feeling, for what it is worth, is that knowing that the money generated is being put into even better health care in that district is normally, for the people who work for us, reward enough.

Dame Elaine Kellett-Bowman: My hon. Friend said that we can leave it to the local district. Do we take it that it would not be illegal if the authority chose to do that?

Mrs. Currie: As long as the money which is generated continues to be used in the NHS—

Dame Elaine Kellett-Bowman: To reward an employee?

Mrs. Currie: I am a little reluctant again to set out what I have said. The main opportunity to reward an employee lies in the grading of the district general manager and one or two other key staff.

Mr. Maxwell-Hyslop: It could work right through.

Mrs. Currie: I take the point entirely. I would not be antagonistic to a suggestion that saw some kind of a reward, as long as the main benefit from such activity and improvement went straight into the Health Service, and therefore was seen to improve the health care of the neighbourhood.
As my hon. Friends know, most of the pay of the people concerned is either negotiated through the Whitley bodies or is offered to us through the review bodies. We do not at this time have the opportunity to vary the pay of individuals in quite the way that my hon. Friends suggest. I commend what they say to my right hon. and learned Friend the Secretary of State for Health. We shall take on board those excellent suggestions.

Mr. Irvine Patnick: Do the additional powers for financing the Health Service include the powers of leasing, placing money on the overnight

money market and borrowing? If this is not readily clear, could consideration be given to this approach to generate income?

Mrs. Currie: The money voted to us for the NHS is to run NHS activity. About 70 per cent. of that money goes in pay. We would therefore expect that the money which we have voted for next year will be allocated in much the same way. How money is held before it is spent is a matter not just for the NHS but for all Government Departments. My hon. Friend the Member for Sheffield, Hallam (Mr. Patnick) may like to refer that question in more detail to my right hon. Friend the Chancellor. The way in which my right hon. Friend handles our money has been entirely beneficial, and we have all heard the results in the Autumn Statement.
Mainly our money is spent. We can spend every penny which is allocated. The purpose of clause 7 is to ensure that those opportunities which occur to a considerable extent in most health authorities can be used to generate income, bring in more money and make a profit where no profit is legal. Money is then available to that health authority to extend and develop its services as it thinks fit and to provide all the services that we would like in health care.

Mr. Fearn: Would the voluntary bodies which are already raising quite a lot of cash for the district health authorities be taken into consideration as well? Would that money be utilised in the melting pot?

Mrs. Currie: We are about to discuss in detail one of the amendments which refers to voluntary bodies and, if I may, I shall take on that point then.
Subsections (9), (10) and (11) provide that charges for NHS treatment of patients from overseas may be set by health authorities on a commercial basis in the same way as charges for private patients. These subsections were added during our earlier consideration of the Bill, largely, again I must confess, because of pressure from the hon. Member for Strathkelvin and Bearsden. Perhaps we should have had him as one of the Bill's sponsors. This is an excellent Bill, as the hon. Gentleman has said a number of times. He even told us that he thought that the White Paper was very good, but whether that will help his career on the Opposition Front Bench is another matter. We welcome the hon. Gentleman's intelligent and sensible comments.

Mr. Sam Galbraith: Get on with it.

Mrs. Currie: Such charges apply only to a small minority of foreign visitors. Most foreign visitors are covered by European Community arrangements—the E111—or are citizens of countries with which we have reciprocal agreements, such as the Eastern bloc countries. Nevertheless, we felt it right and proper that health authorities should be free to set their charges in the same way as they set their private patient pay bed charges.

Mr. Maxwell-Hyslop: Surely a large proportion of our overseas visitors are from the United States, with which we do not have such an arrangement.

Mrs. Currie: I think that that is right. Generally, we try to come to agreements with countries, where possible. It is worth bearing in mind that a large number of our people go abroad. In fact, we have one of the highest proportions of people who go abroad on holiday and then get care and


treatment overseas. We try to make arrangements between Governments so that there are offsetting arrangements wherever possible. I am not aware that we have a huge influx of visitors from the United States coming here for treatment. Generally, they get very good treatment in their own country, and I am sure that they are pleased about that.
I turn to the detailed changes made in another place which we must now consider. The key point is that all the Lords amendments to clause 7 now under consideration were welcomed or accepted by Lord Ennals, the Opposition health spokesman in the other place, and we hope that the same will be true tonight. The 12 amendments before us include three different issues. The first, which is dealt with in amendments Nos. 5, 6 and 10, relates to the general rights of the Secretary of State under clause 7, which is why I gave the House rather a long preamble to them. The second, amendment No. 7, is concerned with the role of the voluntary bodies. The third group, amendments Nos. 8 and 11 to 17, deals with private patients.
Amendments Nos. 5, 6 and 10 were introduced by the Government in another place to meet the concerns expressed there and earlier in the House that the powers which the Government sought in clause 7(1) were too wide. Particular concern was expressed that clause 7(1)(f), and to a degree paragraphs (g) and (h), would affect adversely the rights of academic researchers and others directly employed by the Health Service in respect of exploitation of their ideas and inventions. The opportunity was taken to have a debate, which was extremely valuable, about the revision in February 1987 of the standard Department of Health research contract. At that stage, the fundamental issue was the removal of the automatic right for researchers to publish. The hon. Members for Strathkelvin and Bearsden and for Peckham will recall that we had a long and useful debate about this in-Committee. In the other place, however, there is a strong interest in academia and in the rights of inventors and I took the opportunity to listen to the debate there. The concept embodied in the amendments was offered to those leading the debate and became part of a package including amendment No. 9, which will be moved later by my hon. and learned Friend the Minister of State.
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In the light of the concerns expressed, we decided to introduce these amendments in another place. They make it absolutely clear on the face of the Bill that in using these powers the Secretary of State and health authorities acting under delegated authority cannot do anything which would take away anyone else's legal rights or property, and so on. We did not incorporate the provisions in the Bill at the outset because we did not consider it necessary, but we have bowed to the advice of their Lordships who regard it as necessary and we are prepared to accept the amendments.
Amendment No. 7 deals with voluntary bodies and inserts in page 5, line 32, the words
(having regard to the existing work of voluntary bodies)".
When I have said a few words about this, I will give the hon. Member for Southport (Mr. Fearn) the opportunity to make his point again so that it comes in the right place.
The purpose of clause 7 is to make more money available for improving the Health Service. Clearly, there might sometimes be a potential clash of interests with the

voluntary bodies which work so selflessly in support of the Health Service. Organisations such as the League of Friends and the Women's Royal Voluntary Service, help by running shops, cafeterias and so on in our hospitals. Their help is invaluable and allows the provision of a really useful service which otherwise might be difficult to provide, especially in isolated areas. Some Health Service managers, however, have ambitions beyond the services that such bodies can provide and believe that, with the right encouragement, private companies with expertise in areas such as mass catering or retailing might be willing to rent space in hospitals to run major shops or commercially viable cafeterias. A lot of money could be made by the health authority in terms of rent and additional facilities would be available for patients, visitors and staff.
One major London hospital has calculated that in a typical year the total number of people passing through its front door is about1¼ million. That includes patients, staff and a very large number of visitors. If we can tap some of their activities and offer them opportunities to spend money with us, there is scope for considerable income generation, but we must ensure that in their zeal to set up such arrangements—arrangements which, broadly speaking, we would encourage—Health Service managers do not ride roughshod over the League of Friends, the WRVS and other organisations which might already be working in the area.
Account should be taken, for example, of any existing tea bar and there should be discussion with volunteers about the implementation of new policies. Those running the tea bar might agree that their efforts could be directed to a different form of help—for example, sitting with patients who do not have many visitors or who may feel lonely and depressed and distressed. In the future, as in the past and the present, for many volunteers this may represent a better use of their efforts in terms of making the patients' time in hospital more pleasant or at least less unpleasant rather than restricting voluntary effort to raising money when in many cases more could be raised through commercial activity.
We do not wish to alienate the marvellous people who work with us through the League of Friends and other voluntary organisations. We are ever grateful to the large band of dedicated voluntary helpers who support the Health Service in such a variety of ways. That consideration was foremost in our minds in bringing forward this important amendment, which insists that we have regard to the existing work of voluntary organisations. We hold that work in the highest regard and we commend it to the House. We therefore also ask the House to agree with the Lords in the said amendment.
With regard to amendments Nos 8 and 11 to 17, the Opposition tabled an amendment in Committee at the behest of the British Medical Association which sought to reinstate both the definition of a private patient and the right in statute for consultants to admit their own private patients. To this day I remain certain, and I always shall, that the hon Members for Strathkelvin and Bearsden and for Peckham did not realise the basic purpose and meaning of the amendments suggested by the BMA, but that is certainly what they meant.

Mr. Galbraith: indicated dissent.

Mrs. Currie: If the hon. Gentleman does not believe me, he may care to ask his advisers at the BMA, but that is exactly what those amendments meant.
At the same time, on a completely different point, our lawyers advised us that the revision contained in subsection (7) could well render certain collaborative schemes that we would wish to welcome ultra vires or at least fail to provide a definition of a National Health Service private patient. We were therefore sympathetic to the Opposition amendment, which would have resolved our difficulties as well as theirs had it not been defective, and I undertook to bring forward a suitable Government amendment on Report. Our amendment was virtually identical but at the eleventh hour it, too, turned out to be defective and thus was not moved. I am therefore forced today, as it were, to do a Whitelaw—to apologise yet again to the House for not having got this right in the first place and for having had to withdraw our proposal on the last occasion. With the assistance of their Lordships, however, we think that we have now got it right.
The eight Government amendments tabled in Committee in the Lords reinstate the requirement for the giving of undertakings by private patients and thus provide a convenient definition of a National Health Service private patient. They also reinstate the discretion to make accommodation and services available to consultants for the treatment of their private patients in England, Wales and Scotland. They were accepted in the other House unopposed and it is my privilege today to move, That this House doth agree with the Lords in the said amendments.

Ms. Harman: rose—

Mr. Deputy Speaker: Order. I will call the hon. Lady in due course, but not until I have reminded the House that we have a lot of work to get through. I hope that hon. Members and Ministers will put their arguments succinctly.

Ms. Harman: I shall keep my remarks as brief and as crisp as possible. Unlike the Minister, who is clearly attempting a filibuster so that important items such as charges for eye tests and dental checks will not be discussed until the small hours of the morning, I shall keep my remarks to a minimum.
On amendment No. 5, the Minister was right to mention that DHSS contracts for research were debated at length in Committee in this House and in another place. The concern was that the Government might refuse consent for publication of research merely because the findings did not fit their dogma. In a written answer on 8 March this year, the Minister went some way towards clarifying the situation. I should be grateful if she would go a little further today. Will she confirm that the only reasonable ground for refusal to allow publication would be if the research breaches confidentiality, commits libel or contains factual error? Will the researcher be told which of those is alleged so that he will know why publication is not allowed? Will the researcher or the organisation sponsoring the research have a right of appeal?
We very much welcome amendment No. 7, which deals with voluntary organisations. Such bodies as the League of Friends provide not only services to patients but an important opportunity for the local community, on a voluntary basis, to be involved in the work of their hospitals. Links between a hospital and its community

should not be trampled upon in the rush to commercialise the Health Service. We shall monitor whether the income generation unit abides by the caveat in the amendment. We hope that the Minister will report on how it is being observed and on how the interests of the voluntary organisations in hospitals and in the Health Service at local level are being respected.
I wish to clarify the position on private patients. The Bill originally left out the actual definition of a private patient, so without amendment there would be no definition. My hon. Friends and I felt that to be unsatisfactory and tabled an amendment in Committee to restore the original definition. Being of suspicious mind, we did not believe that the definition had disappeared by accident. We felt that it was more likely intended to clear the way for a further blurring of the distinction between health provision in the public and private sectors. We are satisfied that the definition will now be reinstated.
I hope that the Minister will deal with my points on amendments Nos. 5 and 7.

Mr. Fearn: As I said earlier, the voluntary organisations raise a great deal of cash, which is then used to provide a specific item for a hospital. I would not want that to be interfered with. I hope that, in future, that money will not simply go into the melting pot.
The WRVS is concerned that under the income generation scheme catering firms will take over and the making of profit will mean more than the kindness being offered by the voluntary services. I hope that that will be carefully monitored.

Mrs. Currie: With the leave of the House, Mr. Deputy Speaker, I shall reply. The hon. Member for Peckham (Ms. Harman) mentioned three grounds on which there might be some dispute between the Secretary of State and the researcher, for whose material we had paid, about whether material should be published in a certain form. Indeed, she mentioned three very good grounds on which there might be some difficulty—

Ms. Harman: The Minister gave me that information.

Mrs. Currie: That is right. There might be other grounds—for example, if there was an error of fact we would want an opportunity to discuss that with the researcher. There might be a question of someone being defamed in some way and that, too, would be appropriate for discussion. Although we think that there are unlikely to be any grounds other than those that we have set out, we want to ensure that the Secretary of State has the right to deal with them should they arise. It also brings his powers more into line with the sort of contracts available in other Government Departments.
We would always discus such matters, through our officials, with the researchers concerned. It would never be our wish simply to take an arbitrary approach. We would want to know how the money we had allocated had been spent, because we have to account for that money. We do not have plans for a formal system of appeal, but I assure the hon. Lady that we would have full discussions with the researchers. Indeed, having commissioned the work we would be interested to know how the researcher was progressing.
We are attempting to tidy up the legislation on private patients and get it correct. We want to ensure that it will hold and bite in the way that we want. We agreed at the


outset that some of the definitions being offered were not adequate and would not stand up to scrutiny. We are, therefore, grateful to the other place for its work on that matter. We believe the new wording to be better than the original.
I welcome what the hon. Lady said about the leagues of friends. It is nice to hear that the Labour party is now all in favour of the volunteers who work so hard in the NHS.I hope that it will continue that stance. I am, however, bound to observe that on past occasions volunteers have been criticised by some of the hon. Lady's colleagues, who believe that volunteers and amateurs should not be involved in activities that they think would be better done by paid members of NUPE. I welcome the Labour party's conversion. All such conversions should be welcomed.
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The hon. Member for Southport (Mr. Fearn) made an important point. He may recall that before I came to the House I was chairman of the health authority in Birmingham. I am on record as expressing exasperation because, at that time, voluntary organisations often raised money and bought pieces of equipment without consulting the health authorities, which put the authorities in some difficulty. Recently we have encouraged the health authorities and the fund raisers to sit down and discuss appropriate activities and campaigns. The result is flat the fund raisers are providing far more useful pieces of equipment. Although that brings the criticism that fund raisers should not have to buy useful pieces of equipment, I prefer them to do that than to buy something that is quietly left in a box and not used. I am sure that the hon. Gentleman would regard that as progress. We hope that the cash raised is used for appropriate purchases. To that end, we expect the health authorities to discuss with the voluntary bodies their exact plans for the use of any money raised.
I hope that with those explanations I have outlined the important changes that the amendments make to the clause, which we hope will generate a great deal of money for the NHS.

Question put and agreed to.

Lords amendments Nos. 6 to 8 agreed to.

Lords amendment: No. 9, in page 5, line 46, at end insert—
(4A) The Secretary of State shall exercise the powers specified in subsection (1)(f) above only after consulting (to the extent that it appears to him to be practical) any person who appears to him to have an interest through his own previous research in the ideas or intellectual property in question as to whether he should exercise them and, if so, as to any financial arrangements.

The Minister of State, Department of Health (Mr. David Mellor): rose—

Hon. Members: Hear, hear.

Mr. Mellor: I am grateful for my hon. Friends' touching sign of support, which I hope will subsist throughout the evening.
I beg to move, That this House doth agree with the Lords in the said amendment.
The amendment was incorporated into the Bill with the acquiescence of the Government to address the concerns expressed in another place that there were occasions when patent law did not give adequate protection to inventors over, for instance, whether the invention—and I use that expression illustratively—should be exploited at all, or

whether, for example, its worth was now much more than could reasonably have been expected when an original contract was signed.
Although we felt unable to go the whole way towards meeting the wishes of those who wanted a requirement to obtain the specific agreement of the inventor, we accepted that it would be fair to all parties if the Secretary of State had to take into consideration the views of the inventor over exploitation. That would give the inventor the opportunity to state his case if he had views about the appropriateness of exploitation, and would also give him the opportunity to seek further financial reward if that was an issue.
As I said, this was not a Government amendment in another place, but it was moved with our full support. I hope that it goes a long way to allaying any fears in the research community.

Question put and agreed to.

Lords amendments Nos. 10 to 17 agreed to.

Clause 10

DENTAL SERVICES

Lords amendment: No. 18, in page 9, line 8, leave out from "following" to end of line 15 and insert
subsections shall be inserted after that subsection—

"(1A) It is also the Secretary of State's duty to provide, to such extent as he considers necessary to meet all reasonable requirements—

(a) for the dental inspection of pupils in attendance at schools maintained by local education authorities or at grant-maintained schools;
(b) for the dental treatment of such pupils; and
(c) for the education of such pupils in dental health.

(1B) Schedule [Provisions supplementary to s.1] to this Act shall have effect.""

Mrs. Currie: I beg to move, That this House doth agree with the Lords in the said amendment.

Mr. Deputy Speaker: With this we shall discuss Lords amendments Nos. 19, 46, 47, 49 and 50. I draw the attention of the House to the fact that some of the amendments involve privilege.

Mrs. Currie: The amendment will replace the absolute duty that originally stood in the legislation on community dental services with a duty to provide dental services at a level to meet all reasonable requirements. I think that the profession will regard our concession as something of a victory, but I do not mind that in the least. In practical terms, the proposals will not change the requirement to develop the community dental service.
Labour Members will recall that we had extensive discussions in Committee on how the community dental service should advance. We believed that the community dental service should offer an improved service to those people who have difficulty in obtaining the services of a general dental practitioner. That would remove the requirement for the community dental service to duplicate the services that are already adequately provided by general dental practitioners. The Lords amendments will satisfy the concerns that have been expressed.

Ms. Harman: I want to make two points about Lords amendment No. 18, which concerns the community dental service. First, how much do the Government plan to spend under the new arrangements on the community. dental service? Will existing resources be targeted to where they


are most needed, or will fewer resources be targeted to those who most need them? Secondly, how do the Government plan to ensure that district health authorities comply with the statutory obligation for the dental inspection of schoolchildren and the maintenance of the community dental service? The financial pressure that the Government are putting on district health authorities is so great that many district health authorities see the community dental service as a soft target. How will the Government keep district health authorities up to the mark in respect of the community dental service?

Mr. Peter Griffiths: My hon. Friend will recall that when we discussed the matter in Committee I was keen to press the point that going to the dentist is a family activity. Primary responsibility for dental care falls on parents. There was a difference of opinion between the Government and the Opposition in Committee over the prospect that, following the line of argument that I had put forward, if the requirement that the Secretary of State should provide a comprehensive dental service for children of school age were removed, there might be areas in which the service would not be provided. That was the nub of the political disagreement in Committee.
I am grateful for the fact that we have come to an acceptable compromise. The Secretary of State will have the power to ensure that "all reasonable requirements" are met and, at the same time, it has been made clear that the responsibility to ensure that children receive dental treatment from either general dental practitioners or the service provided by the health authority falls basically on parents.

Mrs. Currie: With the leave of the House, Mr. Deputy Speaker, I shall reply.
I thank my hon. Friend the Member for Portsmouth, North (Mr. Griffiths) for his sensible summing up of where we stand on the issue. However, the Secretary of State will have more than a power in this respect. He will have a duty to provide the service as far as is reasonable. The word "reasonable" will be written into the Bill. It is a sensible compromise between those who insist that we should continue to run the community dental service in the old way—when the main problem was the poor dental health of children in particular—and those who see that the general dental practitioner service is first class and who believe that it is entirely right and appropriate that people should go to the dentist as a family, including such important people as the spouses of hon. Members and other people who regard dentistry as important.
The hon. Member for Peckham (Ms. Harman) spoke about the mechanism for ensuring that the legislation is followed and that the law is obeyed. The mechanism is the review system in which Ministers review the regional health authorities and the chairmen of the regional health authorities and their colleagues review the district health authorities. As I mentioned at Question Time this afternoon, Basingstoke and North Hampshire district health authority is being reviewed today. We expect the quality of work that the community dental service does and the degree to which it responds to patterns of dental health to be taken into account in such a review and for the health authorities to be held accountable.
The hon. Member for Peckham also asked whether more or less money was to be given to the service. That is a matter for the district health authorities to decide. If the hon. Lady re-reads the White Paper, which sets out some of the provisions that we are discussing tonight, she will find that we have proposed other functions for the community dental service which need to be developed, such as the monitoring of levels of dental health and the care of special groups. It is not just a question of how much money we spend; it is a question of what we get for that money. Dental health in this country is improving extemely fast, and we have been able to identify and look after some groups that have had little dental care in the past. We are determined that the community dental service should fulfil that obligation and look after dental health in a much more general way.

Question put and agreed to.

Lords amendments Nos. 18 and 19 agreed to—[Special entry].

Clause 11

CHARGES FOR DENTAL APPLIANCES AND TREATMENT

Lords amendment: No. 20, in page 12, line 1, leave out subsection (7).

The Secretary of State for Health (Mr. Kenneth Clarke): I beg to move, That this House doth disagree with the Lords in the said amendment.
The House will know that the amendment deals with the vexed question of charges for dental examinations. I shall seek to persuade the House this evening that their Lordships made an error when they sought to remove the power from the Bill, and that the Health Service can make extremely good use of the revenue that can be raised by the introduction of charges.
It is relevant first to consider the matter against the background of the Autumn Statement and the increased spending announced today. I know from discussions with some of my hon. Friends that that announcement may be used against me by some. The argument runs that, with so much money going into the National Health Service, we do not need to seek increased revenue from those of the population whom we judge can well afford to pay a modest sum for their dental examinations. It is certainly true that this debate is taking place against the background of a fairly dramatic increase in the spending available to the National Health Service next year.
Given the difficulty of absorbing the Autumn Statement, it is possible that not all hon. Members have yet assimulated the news that we have heard. The hon. Member for Livingston (Mr. Cook) described the announcement as a standstill budget. I do not understand that. It would appear from some of the hon. Gentleman's comments that he may be labouring under the misapprehension that the increased spending that we provided to fund in full the nurses' regrading exercise and pay increase is part of the £1·8 billion for England. I see that he is shaking his head, so he has appreciated that fact. What we are talking about by way of provision by the taxpayer is an increase in spending next year over and above the outturn this year, which includes all the money that we have provided for the nurses' regrading exercise and that will continue. Over and above what we have provided this year for the Health Service, and over and above the provision that we have made for the funding of the nurses' pay award, an additional £1·6 billion—£1,600


million—will be provided for the Health Service next year in England alone. On top of that, we expect continued efforts by way of cost improvement programmes and revenue generation—made easier by the Bill—to make available to the English National Health Service £1·8 billion.
The hon. Member for Livingston would not forgive me if I excluded Scotland, Wales and Northern Ireland from my remarks about the Health Service. If those figures are included, the increased spending available to the Health Service next year amounts to well over £2 billion—4½ per cent. over and above the raised forecast for inflation announced by the Chancellor today. That figure includes increases in expenditure on primary health care, with which we are principally concerned this evening. At the moment, we are spending more than £5,000 million on primary health care. During this Government's period of office, the figure has risen substantially—by 43 per cent. over and above the level of inflation since 1979. Our public spending proposals include plans to increase spending on primary care services by a further £600 million over the next few years.
The National Health Service is faced with a splendid opportunity to expand its patient services—while maintaining the high quality of medical and nursing services that we know we can expect from it—to meet the increasing demands that today's population puts upon it. The relevance of that is that there may be a temptation among hon. Members on both sides of the House to say that because this money has been made available, thanks to the Government's choice of priorities in this year's public spending round, we can take it easy and relax a little.
Why do we need to look for the provision of further revenue for the Service by introducing charges for dental examinations? I hope that that reaction to the large increase in provision for the Health Service will not affect the House, and will not affect people in the National Health Service either. We will waste the opportunity that the present economic success of the country has given to us if we allow increased spending by the Health Service to be combined with easing off all that we have done to try to give priority to patient care and developing the Service from the resources that we have.
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The same mood could affect National Health Service managers. There will be a temptation in some authorities to defer a difficult closure decision, even if the hospital is redundant to Health Service needs and the money could be used elsewhere. There may be the temptation, which I fear will be encouraged by some members of the trade union and Labour movement, to ease off in our efforts to raise efficiency and to make better use of our manpower. That would be a mistake and would dissipate our opportunity. I believe that it would be a mistake for the House to reverse the decision that we took before the summer recess to give these powers to raise further revenue for the Health Service by charging for dental examinations. There is a choice in all things, and there is a clear choice when hon. Members decide which way to vote on this amendment.
We are talking about dental charges that will raise nearly £50 million in a full year. The best estimate that we can make for what those charges could raise is £49 million. The choice that faces us is whether we raise that £49 million and put it into improving the service to patients

provided by the National Health Service or whether we allow it to stay in the pockets of that section of the population who would not qualify for exemption, those who are, by definitions better off. The sum of £49 million is not insignificant. The choice that their Lordships made in another place was to let the people who would otherwise pay keep the money and not to put that money into the National Health Service.
When one looks at what £49 million would buy, it is equivalent to at least one new district hospital each year. If one takes the average cost, it would pay for 21,000 hip replacement operations each year. It would pay for more than 65,000 cataract operations at the average cost, if that £49 million was put to what I regard as better use. To find out what can be achieved on the margin of the Health Service, one only has to look at the Government's recent waiting list initiative. By spending £30 million on the margin, we have been able to provide treatment for 110,000 more in-patients in hospitals. The £30 million for the waiting list initiative is dwarfed by the money that we expect to raise from dental examination charges.

Sir Michael McNair-Wilson: Will my right hon. and learned Friend say whether the £49 million represents the number of people who are having dental examinations at this time, or is it an estimate of the number who may have them if the charges are imposed?

Mr. Clarke: I shall be coming to that crucial point in my speech. I do not believe that the dental charges will have any significant or noticeable effect on the number of people who have dental examinations. That is probably the issue that divides some of us most strongly this evening, but I believe that all experience is against that.
The £49 million is the sum at issue on this amendment for dental charges. It is no good saying that £49 million does not matter and that it is peanuts, and it is something that surely can be found from the Government's finances in their present state. It is not peanuts to the people who could have those extra operations or treatment in some other part of the Service if we allow this revenue to be raised and used properly. It is no good saying that, if the House reverses the decision that it took a few months ago and decides that, after all, it does not want to raise this revenue, we will somehow reopen the Autumn Statement and find the money to replace it. That is simply not on. I understand that an hon. Member put that to my right hon. Friend the Chancellor of the Exchequer earlier. One cannot run a whelk stall that way, let alone a Government.
On this year's spending, the settlement that we have made in United Kingdom terms is more than £2 billion extra spending over and above this year's spending, over and above the nurses' pay settlement and over and above the £50 million that we are planning to spend, and which I certainly do not wish to forgo. I hope that that explains to my hon. Friends—it may come as a surprise to some of them, but it should not—why the discussions on this year's public spending round were not easy. I have the greatest respect for my right hon. Friend the Chief Secretary, who is also a personal friend. We discussed this matter for a long time. One meeting that we had lasted for five and a half hours. At the end of it, we had not settled very much, so we had to start again. Throughout those discussions I never reopened this question, because the Chief Secretary himself wanted to give higher priority to the Health Service and its patient care. They were friendly


discussions, and neither of us wanted to go backwards and take out of the Service £50 million for dental charges, of which we believe the Health Service can make adequate use.

Mr. Maxwell-Hyslop: rose—

Mr. Peter Griffiths: In the list of improvements that my right hon. and learned Friend has suggested could be made in the National Health Service from this £50 million, he has made no mention of any improvements in dentistry. Our right hon. Friend, the then Minister of Health, said in Committee—at column 262—that at least part of it would go into improved primary dental care.

Mr. Clarke: I know. I am trying not to repeat the arguments that my right hon. and hon. Friends have used extensively on Second Reading, in Committee and on Report, though I am bound to repeat some of them. Some money will be put into dental services, and that is something for which the Bill is paving the way. Measures are included to promote dental health and the prevention of dental disease, and to improve the quality and distribution of dental services. Those extend from more fluoridation to more training for the dental profession.
I must say to my hon. Friend the Member for Portsmouth, North (Mr. Griffiths) that it is no good anyone thinking that they can vote against the new dental charges and not put any of those at risk. I am sure that we shall not be able to charge ahead improving dental services as the profession expects, quite rightly, that we shall do if the House decides to deny us £50 million that we believe we can legitimately raise from dental charges. We shall have to find the £50 million out of our previous intentions. The dental service need not think that it will be exempt, if the dentists have persuaded the House not to introduce these charges. However, I trust that we shall not come to that.

Mr. Maxwell-Hyslop: Is my right hon. and learned Friend telling the House, as a new Secretary of State in the Department, that his right hon. and learned Friend, the Parliamentary Secretary to the Treasury so failed in his duty to him that he did not warn him that, when he met the Chief Secretary to the Treasury, he should do so on the supposition that there was a great probability that the original decision of the House would be reversed and that, the Lords having passed this amendment, it would very possibly be sustained by this House? Is he telling us that he had no advice whatever from the Parliamentary Secretary to the Treasury on this matter? He has told us that he went into his meeting with the Chief Secretary to the Treasury not taking this into consideration. Did he or did he not have advice from the Parliamentary Secretary to the Treasury on this point? If he did not, the Parliamentary Secretary to the Treasury let him down severely.

Mr. Clarke: I have had a number of conversations on this subject with my right hon. and learned Friend the Parliamentary Secretary to the Treasury since I took up my post. He, together with my right hon. Friend the Secretary of State for Social Security, took the measure through the House only a few months ago and received an adequate majority of, I believe, 81 for it. We know that since then people have reflected further, but the fact is that, although some of those hon. Members who now say that

they are leading a rebellion against us voted in favour of these charges only a few months ago, they now claim to see great problems of principle. However, my right hon. Friend the Chief Secretary to the Treasury and myself have great faith in the logical approach—especially of our party—to these matters. We trust that when confronted with the use to which £49 million could be put—and, I hope, having considered whether there is any serious risk of people being deterred from treatment—we shall achieve that majority, or something like it, again.

Mr. Churchill: rose—

Mr. Clarke: I shall give way to my hon. Friend in a moment. The danger in these debates is that I shall be giving way all the time. I shall come to any deterrents later.
I would point out to my hon. Friends—this is also appropriate to the Labour party when it was in government—that in primary health care it has always been the policy of successive Governments that those who are comparatively better off when compared with the very poorest in society should contribute to the cost of optical, dental and pharmaceutical services. That point has not been raised as an issue of principle on all but the briefest of occasions since Nye Bevan found it objectionable in 1951, when the then Labour Government introduced charges. What has happened—not only during this Government's period of office—has been that those charges have been raised substantially. In our opinion, those charges are a proper contribution to the revenue that is required to support and improve primary health care services. I have already said that we have increased real terms expenditure on those services by 43 per cent. since we came into office.
At times I have taken part in the debates that have been held each year on health charges. I am afraid that at times I have regarded them as a bit of ritual and I believe that I have said so on occasions because when in opposition the Labour party makes ritual objections. On every occasion when we raise charges, people always say that that will have a deterrent effect on those people coming forward to seek treatment. I have no doubt that some hon. Members raised that point as long ago as 1976 when the Labour Government raised charges by 35·3 per cent. in one year and then raised them in the next year by 27 per cent. Our biggest increase was 32 per cent. in 1980 and in subsequent years we have always raised charges. The real terms level of those charges has always increased because the real terms cost of primary health care has always increased.
We have frequently had votes on those issues and some hon. Members have asserted that the old and the poor would be deterred from using the services if we carried on increasing the charges for non-exempt groups. However, it has never been the case that there has been any decline in the service. In fact, although Governments have increased the level of the charges every year, there has been a steady increase in the numbers of courses of treatment. Occasionally, there has been a small drop in the first part of the year, but by the end of the year—I have with me the figures for every year from 1975 to 1986–87—the numbers of courses of treatment have increased.

Mr. Churchill: rose—

Mr. Robin Cook: rose—

Mr. Speaker: I call Mr. Robin Cook.

Mr. Cook: I am obliged to the Secretary of State for giving way to me. For the guidance of the House, will the Secretary of State clarify whether the chief medical officer agrees with him that he would not expect people to be deterred by a charge for dental examination or has the chief medical officer offered the Secretary of State the medical advice that that would greatly damage an important preventive service?

Mr. Clarke: I regard the advice of the chief medical officer—as I regard the advice of all my officials—as confidential—[Interruption.] I also regard this issue as tedious. The hon. Gentleman raised it repeatedly with my predecessor. He should be careful because, although his reputation is justifiably high, he blew his attack on the Government and child benefit last week by becoming obsessed with a silly letter that someone had got for him, thus throwing away any opportunity to satisfy even his hon. Friends. If the hon. Gentleman wants to take us back through his exchanges of correspondence with my predecessor about the advice of the chief medical officer, he can occupy the time of the House in that way if he wants, but I am certainly not going to move away from the long-standing convention that such advice is confidential.
The key point is that there have been steady increases in the numbers of courses of treatment every time that we have raised charges. Some of those charges are now quite high—the present maximum being £150 for a treatment. We did not start raising charges—our predecessors did that—but we have never apologised for raising charges to pay for treatment. The cumulative effect is that during our period of office, from 1979 to 1987, courses of dental treatment have risen from 31 million per year to nearly 37 million per year. That is an increse of 19 per cent. and means that there are almost one fifth more instances of people using primary health care than when we started hiking up the charges. There has been an annual increase of about 2·7 per cent.
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Looking at the figures for the use of the dental service, what strikes me is that the group of the population which has raised its use of dental services more than any other is pensioners and retired people. Each year we have increased charges and each year the Labour party has gone through the ritual of opposing that, yet pensioners' use of dental services has risen faster than that of any other group. During the lifetime of this Government, pensioners' use of dental services has nearly doubled. There has been a 92 per cent. increase in the period from 1979 to 1987.

Dr. Lewis Moonie: rose—

Mr. Churchill: rose—

Mr. Clarke: I shall give way to my hon. Friend the Member for Davyhulme (Mr. Churchill) because I think that he was first.

Mr. Churchill: I am grateful to my right hon. and learned Friend for giving way. He seems to be under the firm impression that by introducing or raising such charges he stimulates the uptake—[Interruption.]—or at least there is no decline. Is he going to tell us that he is about to introduce charges for breast cancer screening and for

cervical smear testing and that that would not have a deleterious effect on the uptake? If he does, quite frankly not many people will believe him.

Mr. Clarke: With great respect to my hon. Friend, who is a colleague of long standing, he does not do me a service by slightly parodying my argument. Of course, I was not saying that levying charges would in itself encourage a greater uptake—[Interruption.]—well, some people might be tempted to. It is not usually the experience that people have less regard for something that they pay for than for something that they get free. However, I have not used that argument. I am saying that against the history of some pretty steep increases in the costs that people expect to face when they cross the threshold of a dentist's surgery, the public are making ever more use of the dental service—pensioners most spectacularly.

Dr. Moonie: rose—

Mr. Hugh Dykes: rose—

Mr. Clarke: No. Of course, we are not introducing charges for those other things. I am putting the current position firmly in the context of the long-standing charges for optical, pharmaceutical and dental services. We have absolutely no proposition to put forward charges for those other screening tests.

Dr. Moonie: The Secretary of State has correctly described the long-term trend in the use of the service. Will he confirm that on every occasion in the past 10 years on which charges have been raised the level of usage immediately thereafter has fallen?

Mr. Clarke: I think that I have said that. What usually happens is that its use falls off for a short time, but uptake then catches up. I will not labour that point any further because the figures are plainly on my side.
The increase in the use of the dental service coincides with a period during which the dental health of the nation has been improving. The number of people who have rushed to the dentist for toothache, for extractions and for fillings is certainly not increasing—if anything, it is decreasing. However, people are making ever more use of the dental service for the most expensive treatment such as bridges and crowns.

Mr. Dykes: rose—

Mr. Clarke: I should like to continue my case for a little longer and then I shall give way again. The case that I am making—and I am not putting it in the manner that my hon. Friend the Member for Davyhulme suggested—is that all our experience shows that quite sharp increases in charges under both Labour and Conservative Governments have not deterred people from going to the dentist. Therefore, there is no reason to believe that the impact of charges on this test will be any different from the impact made by those other charges.
I shall go further, because if there is any deterrent effect—I recognise that the hon. Member for Kirkaldy (Dr. Moonie) clearly does not believe that there has been no impact—on those seeking treatment, the impact of the charge that we are proposing for this test is likely to be much less—indeed, non-existent. [Interruption.] We shall have two debates and I shall deal with each test in turn because the arguments are slightly different.
The charge that we are proposing for the dental test is tiny compared with most dentistry costs and is not a significant figure for the group of people whom we are discussing who are, by definition, not the very poor and are not exempt. We intend to apply to the test the same principle that we apply to other dental services. The charge represents three quarters of the cost of treatment or, in this case, the examination, so, under the present agreement with the profession regarding the level of reimbursement for the service, the charge will be £3·15 for those people who are not exempt.
That leads me to the key point, which explains why the charges for treatment have not deterred people from going to the dentist. There are more than 20 million people to whom none of this applies because they are exempt from any form of charge. About 38 per cent. of the population is exempt. I have been a little generous to my critics when I have occasionally talked about the one in three who are exempt and the two in three—the better off—who have to pay. That is under-selling our case a little. In fact, four out of 10 are exempt, and the better-off six out of 10 will have to face this enormous sum of £3·15 about every six months if they want to go to the dentist. The exempt groups are children under 16, students under 19, other young people under the age of 18, pregnant women and nursing mothers and people on low incomes, which means primarily people receiving income support or family credit.

Mr. Dykes: I am loth to interrupt my right hon. and learned Friend's beguiling advocacy, but, on reflection, does he not consider that he was a little unfair to our hon. Friend the Member for Davyhulme (Mr. Churchill) who voiced Conservative Members' anxieties? Does he further agree—assuming that he wins vital votes for the Government tonight—that Conservative Members are anxious that, when the charges are imposed, they may be rapidly increased? I have the greatest respect for him and believe that, if the National Health Service were to be safe in anyone's hands, it would be safe in his, but is he not the victim of a long-term Adam Smith design to impose charges on all sorts of screening services in hospitals, clinics and other institutions? Why does he not acknowledge that anxiety and assure us that, if the use of screening facilities falls drastically—assuming that the Government win the vote and impose the charges—he will reconsider the matter in, say, a year's time? Will he also solemnly reassure the House that he does not intend to impose additional charges on other screening services?

Mr. Clarke: No, I have no intention of introducing charges on any other things. As my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) may recollect from our previous exchanges about eye tests, I never say never in politics, so I will say now, as I said on those occasions, "for the time being". I am certainly not party to any desire to extend charges. [Interruption.] It would be a totally different argument if we did so.
I see what we are doing this evening as being consistent with a long-standing policy, which goes back 30 years, of imposing charges for optical, dental and pharmaceutical services. It would be a significant change of policy if we introduced charges for medical procedures such as those that have been cited. Certainly, the Government and I have no such present intention. The Autumn Statement

contained no provision for any new charges, but that does not alter the case in respect of the dental examination charge for the 60 per cent. of people who are not exempt. That charge of £3·15 is incurred about once every six months by that section of the population who go to the dentist. My right hon. Friend the Secretary of State for Social Security made an announcement last Thursday about the uprating of benefit and, as a result of that, a further 90,000 people will be exempted from dental charges. It was a side effect of my right hon. Friend's welcome statement that that widened the category of people in receipt of benefit and who are, therefore, protected against this sum of £3·15.
It is not just the history of charges, but common sense that tells us that people will not be deterred by that sum. Common sense sometimes needs to be reinforced by research. Plenty of research cited in debate has been carried out among that section of the population which probably comprises quite a large number of hon. Members and who do not usually go to the dentist for a dental examination. When those people were asked why they do not go to the dentist, the cost of treatment, which can be up to £150, was ranked fourth among the reasons given, the principal reason being that many people do not see the need to do so. They also cite the pain, and the difficulty of finding a good dentist. Then comes the possibility that it might cost them money.

Dr. John Reid: rose—

Mr. Clarke: Among better-off people, attending the dentist for a regular examination is largely a matter of attitude and habit. Those attitudes and habits are changing. In the past 10 years, the proportion of the adult population attending a dentist regularly has risen from 44 per cent. to about 50 per cent., despite the increases in charges.

Mr. Anthony Steen: Will my right hon. and learned Friend confirm that pensioners with no source of income other than their state pension, although they might have their own home or flat, will not have to pay dental or eyesight charges?

Mr. Clarke: I can certainly confirm that point and it is important that we do so. Concern is often expressed about pensioners in such debates, for reasons that we all understand, but the social pattern of the country has changed in recent years and it is no longer the case that everyone of pensionable age can be assumed to be in the poorest category. Some pensioners are pretty hard-up, but others have quite large disposable incomes.
We give the same protection to pensioners as we give to the rest of the population. That is based on the best possible foundation, that of their income and means. The people in the category described by my hon. Friend do not have to pay for dental tests and the poorest pensioners, certainly those relying solely on their retirement income, would qualify for income relief.

Mr. Nicholas Bennett: In order to put the £3·15 charge every six months into perspective, in comparison with other costs for families, will my right hon. and learned Friend confirm that the family expenditure survey shows that the average family in this country spends £8 a week on alcohol and £3 a week on toiletries?

Mr. Clarke: The average family also spends £4·50 a week on tobacco. [Interruption.] My hon. Friend's point is perfectly valid. Given the expenditure pattern of any household in this country, an expenditure of £3·15 every six months is an infinitesimal part of the household budgets of all those people who do not fall into the exemption categories. We shall waste the resources available to the Health Service if we continue to provide this examination free to a large section of the population who would pay it without thinking seriously about it and thereby contribute a sum of £50 million each year to the resources of the Health Service.
That is my case. We are discussing a misplaced sense of priorities which suddenly seized their Lordships when they first considered the matter. Just as they exercised their undoubted right to send the measure back to us to reconsider it. I strongly believe that we should exercise our undoubted right to send it back to their Lordships for them to reconsider it when they see the consequences for National Health Service spending and treatment.
6.30 pm
The vast majority of the £50 million that we forgo—in my opinion all of it—is wasted. It will be a case of resources needlessly turned aside if the House votes against the Government. Those who occupy the Chamber do not constitute a typical cross-section of the population, but by definition all of us are not exempt from Health Service charges. If the House decides to agree with the amendment, everyone sitting in the Chamber will be able to continue having dental examinations scot free. I am sure that no hon. Member would argue that he would be put off by having to pay a charge of £3·15. I am sure that the majority of those whom we are talking about would similarly not be put off. The £50 million that we are forgoing is dead money that is not serving any useful purpose. It is a source of revenue of which the Health Service could make good use.

Mr. Jerry Hayes: Will my right hon. and learned Friend give way?

Mr. Clarke: No, I shall not give way. [HON. MEMBERS: "Give way."] My hon. Friend and I are familiar with our mutual views. I am sure that I shall continue to exchange views with him on radio and television. He will have plenty of opportunities to express his views. As he feels so strongly about them, I am surprised that he has come in so late in the day. My hon. Friend is protecting those members of the population to whom I have referred against expenditure of £3·15 every now and again.
Labour Members have surprised me. I thought that they would he wedded to the principle that the better-off section of the population—we are talking about the comparatively better-off by definition—should contribute towards health services for the population as a whole. It seems astonishing that the Labour party should seek to protect higher-rate taxpayers from having to incur a penny piece of expenditure for their dental examinations. The Labour party is saying that the £50 million that might be spent each year on patient services should remain in the pockets of the non-exempt population. I trust that my right hon. and hon. Friends do not agree with that.
I am not prepared to agree with the argument that the National Health Service should cut its planned expansion to the extent of £50 million, or to any other extent, for the non-exempt categories. I believe that all those who are

committed to the NHS and to the expansion of patient care, and who wish to see us continue to make further advances in increasing the quality and quantity of health care, will vote in support of the Government this evening, and in so doing disagree with the Lords in this ill-thought-out amendment.

Mr. Robin Cook: This is the first of two debates on a principle that has greatly exercised many hon. Members on both sides of the House. As it is the first of the two, it may be appropriate to begin by rehearsing the recent history of the Government's disturbing proposals. They have their roots in the Green Paper on primary care which the Government produced in April 1986. I am bound to observe that one needs to be the most keen and enthusiastic gardener to spot the roots in the Green Paper. There was not the slightest hint that the Government intended to introduce charges for dental examinations or eye tests. There was no suggestion of the most controversial proposal that the Government have brought forward on primary care.
The first question that I must ask the Secretary of State, especially after listening to his address to the House, is why, if the Government had it in mind to introduce the charges when they produced the Green Paper, they did not share the idea with the world at a time when the public and expert opinion could have commented on the proposal and perhaps saved the Secretary of State from the embarrassing and difficult position in which he now finds himself in defending what is a friendless proposal. No one put that in the Government's mind during the consultation period that followed the introduction of the Green Paper. In answer to a question by my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), the Government candidly stated that no one during the consultation period had suggested charging for dental examinations or eye tests.
The proposal surfaced, newly born but fully fledged, last year in a White Paper. Having produced proposals without consultation, the Government have refused to listen to what anyone has to say about them. I congratulate the Secretary of State and his predecessor on the unusual achievement of securing positive harmony, not merely a degree of unity, among the diverse Health Service lobby groups and professional organisations. They are united in condemning the proposals. Charges for dental examinations and eye tests have been condemned by the British Dental Association, the British Medical Association, the Royal College of Nursing, the Faculty of Community Medicine, the Royal Society of Health, the King's Fund Institute, the Society of Family Practitioner Committees—despite the fact that the Secretary of State has called for all future appointments to be submitted to him for political vetting—the Imperial Cancer Research Fund, the Patients Association, the National Consumer Association and the Association of Community Health Councils.
The Secretary of State told me that he regarded it as tedious to be asked to acquaint the House with the views of the chief medical officer. We all understood what he meant when he said that. I am prepared to give him the chief medical officer. I shall no longer press him to tell us what advice he gave. I merely invite him to name one reputable medical body that is supportive of the proposal to introduce charges for dental examinations and eye tests. By "reputable medical body", I do not mean those


factories for ideological axe-grinding such as the Adam Smith Institute and the Institute for Economic Affairs, which are the only friends of the proposal left.
All medical opinion outside the Department and, as far as we can see, inside it has advised against the charges. We are told that the charge for a dental examination is to be only £3·15. Those who say "only £315" show a remarkable lack of understanding of what that sum means to somebody on £100 a week. There are those who talk about the price of a pint of bitter, and if any hon. Member pays £3:15 for one I shall be glad to invite him to my constituency, where he can be entertained much more cheaply.
We all know what happens to charges under the Government. As the hon. Member for Harrow, East (Mr. Dykes) has said, charges are increased or, as the Government would describe it, reviewed. Some of us remember when prescription charges were only 20p. Since then the cost of such a charge has multiplied 13 times. With that rate of inflation, we shall have a £40 dental examination charge within nine years. Such an increase would be rather faster than the rate of wage increases. It is ironic that the new charge is being imposed in the one area of health policy where the deterrent effect has been repeatedly proven.
The Secretary of State has denied that charges for dental treatment would result in any form of deterrence. I take issue with the right hon. and learned Gentleman. I shall give two examples that have arisen since the House debated the issue on Report in May. The first example is the result of the change in the age of exemption which was made in 1981. Until 1981, any youth under 21 years of age was exempt from charges for dental treatment. In 1981, the Government reduced the exemption level to 18. Until 1981, the number of courses of dental treatment for 17 and 18-year-olds was almost identical. There was only a marginal diference between the two age groups. In 1982, there were 710,000 courses of dental treatment for 17-year-olds and only 554,000 for 18-year-olds. It was not, as the Secretary of State would have us believe, a merely temporary effect to be wiped out by long-term trends. In 1986, the last year for which we have figures, there were 632,000 courses of treatment for 17-year-olds and only 495,000 for 18-year-olds. The figures are eloquent testimony to the fact that among this age group there was a marked deterrent effect following the introduction of dental charges.

Mr. Robert Key: I have also seen the figures, but I place a completely different interpretation on them. They show the remarkable success of preventive dentistry and the fact that children's teeth over the years have become very much better.

Mr. Cook: I cannot express just how glad I am that I gave way to the hon. Gentleman. If he seriously believes that the success of the treatment of 17-year-olds explains the 30 per cent. drop in treatment among 18-year-olds, I have no doubt about which Lobby we will find him in when the Division bell rings.
I want to adduce another piece of evidence for our case which comes from the other end of the age spectrum where the effect of dental charges has been clearly established to have had a deterrent effect. My point relates to a study of

dental treatment among pensioners published by Health Care UK in August. It showed that among pensioners liable to pay for their dental treatment, only half as many as were exempt were likely to opt for expensive treatment. There was a very clear and statistically clear difference. It is more worrying to note that the study showed that those pensioners liable to pay were four times as likely to require emergency treatment when they went for treatment. That shows that that group, because they knew that they had to pay, put off going to the dentist until the crisis occurred. How much more likely is that to occur if those pensioners now have to pay not simply for treatment, but for the check-up?
There is only one conclusion. As a result of the measure, we will see a serious reverse in the long, slow advance in preservation work by dentists. It is inevitable that there will be a tendency to an increase in extractions and loss of teeth as a result of people coming too late for successful intervention.
The Secretary of State made much of the fact that he was saving the Health Service money. He said that he would save £49 million which could be spent to improve primary care. There can be no better way of spending £49 million on primary care than to ensure that people are encouraged to go regularly for a dental check-up and have no disincentive to do that.
I do not want to embarrass the hon. Member for Davyhulme (Mr. Churchill), but I strongly endorse his observation. Every argument of principle used by the Secretary of State to defend the charge could be applied to every other case of preventive medicine. As I listened to the Secretary of State's arguments, I thought that the same arguments would sound equally valid and nonsensical were the Secretary of State to come to the Dispatch Box and say that he was proposing to introduce a charge of £3·15 for a cervical cancer smear. We can see all the arguments that could be adduced: it is not much, it is the price of three or four gin and tonics; there is no evidence that it would stop people coming forward; women surely value their lives more than £3·15 and, indeed, encouraging them to pay £3·15 might make them value the smear all the more. Were the Secretary of State to do that, he would be drowned in a gale of derision because the whole point—[Interruption.] If my hon. Friends will allow me, the Secretary of State would be drowned in a gale of derision from the Opposition Benches.
I want to refer to Conservative Back Benchers. When the hon. Member for Pembroke (Mr. Bennett) intervened in the Secretary of State's speech, I was fascinated to hear the right hon. and learned Gentleman say that the hon. Gentleman's arguments were "perfectly valid." The hon. Member for Pembroke played a distinguished part on Report when we debated this issue. Sixteen Conservative Members took part in the debate and the hon. Gentleman was one of only two who supported the proposals. I warn the Secretary of State that the hon. Member for Pembroke was engagingly frank about why he supported charges. He made it clear that he was in favour of charging for everything provided by primary care—visits to GPs and the rest. That is the argument which the Secretary of State found "perfectly valid."

Mr. Nicholas Bennett: I did not actually say that. I said that I was in favour of a charge for going to the doctor for those who could afford it. That is different from saying that every piece of primary health care should be charged


for. That is a perfectly reasonable case to put. It is not a case which so far has the acceptance of the Government, but that does not mean that Conservative Members cannot engage in a debate on where the Health Service is going.

Mr. Cook: I do not want the hon. Gentleman to misunderstand me. I welcome his presence and candour. However, I rather doubt whether the Secretary of State does the same. The Secretary of State should note where this "perfectly valid" argument is taking him. It is taking him, as the hon. Member for Pembroke honestly and fairly made clear, towards charges for visits to doctors by those who can afford them.
The arguments are well understood and well known. They are well understood because we have been over this ground—

Mr. George Walden: Will the hon. Gentleman give way?

Mr. Cook: No. If the hon. Gentleman will allow me, I will continue, because many Conservative Members want to intervene in the debate and I am anxious to leave adequate time for them.
The arguments are well understood because we have been over this ground before. It is worth recording that on every occasion that we have done that, the Government have lost the argument. They lost it on Report and in another place and that is why we have returned to it today. Latterly in ministerial briefings, a new and rather unpleasant theme has surfaced. Journalists have told us that the Government are determined to get their business through. They will not back down. The Secretary of State may he wet, but he will prove that he is tough. I am referring to the same Ministers who have discovered that they are such sticklers for constitutional convention that they regard it as improper to tell us what the chief medical officer advised them.
A much greater constitutional convention is the function of Government to listen to Parliament. The will of Parliament on this matter is perfectly plain. It was shown on Report and in the vote in another place and it was shown in an early-day motion. The Secretary of State knows perfectly well that if there were a secret ballot on the proposal, he would go down. His only hope of surviving is if his right hon. and learned Friend the Member for Ribble Valley (Mr. Waddington) and his hon. Friends stand at the right doors and the wrong doors and smile menacingly at hon. Members who go through the wrong one.
The Secretary of State does not demonstrate strength by refusing to admit that he is wrong and cannot convince anyone. He shows weakness. There can be no greater display of strength than for the Secretary of State to tell us that he has gathered the views of those working in dentistry and listened to his colleagues and he has changed his mind and will not proceed. There is still time for him to show that strength of mind at the end of this debate. However, if he persists in ignoring the views expressed in the Chamber, he must be defeated in the Division.

Sir George Young: It is common ground between both sides of the House that the National Health Service needs the extra resources announced today, which I am sure we all welcome. It is also common ground that it is perfectly legitimate for the users of the NHS to

make a contribution towards its costs. Under both Labour and Conservative Governments there have been charges for prescriptions and dental treatment.
The Conservative party has always made it clear that it is part of our philosophy to try to reduce direct taxation partly by cutting public expenditure and by increasing indirect taxes and introducing more realistic prices for parts of the public sector. As my right hon. and learned Friend the Secretary of State has already said, since we have been in office we have increased substantially prescription charges and charges for treatment without a lot of heart-searching and weekend activity by the Whips.
Those who subscribe to the deterrent argument against charging for dental treatment have to bear in mind the substantial increases that we have already introduced, which we have all defended, partly by saying that the money goes to improve the quality of service provided by the NHS, but also by arguing that those who benefit directly from parts of the NHS should make a modest contribution if their means permit it.
The debate this evening is about whether dental charges are simply an acceptable extension of a principle that has already been conceded or whether they raise a new issue that makes them unacceptable. Of course I am influenced by the fact that a large number of my hon. Friends with whom I usually instinctively align myself find themselves deeply unhappy about the charges.
However, anyone who visits his dentist for a check-up has already accepted that he may end up paying. There are about 37 million treatments a year and 8 million check-ups, so it follows that most people who go to the dentist know that at the end of the day they will have to pay something. Indeed, part of the point of going to the dentist for a check-up is to find out whether one needs treatment before a problem becomes painful. What the proposals are doing in practice is to substitute the inevitability of a charge with the probability of a charge. I do not find that unacceptable. I do not find any matter of high principle at stake, particularly if the charge is only £3·15.
My right hon. and learned Friend referred to the survey. I hope that he will use that survey not just to reinforce his case in the debate but to look at the three most important reasons why people do not go to the dentist and launch a campaign with the dental profession to bring down those barriers. Many of us would be reassured if, when he replies, there was some sign that that survey was being taken seriously and that there would be a campaign to promote more visits to the dentist.
However, there is another reason for querying the reservations of my hon. Friends. I do not accept the distinction between diagnosis, for which one must not charge, and treatment, for which one can charge. With the development of preventive medicine and health education, that distinction is being blurred. We should not encourage people to believe that they have been treated if they are given a prescription or have a tooth removed, but have not been treated if they are given some helpful advice or friendly warning about their lifestyle, diet or smoking. The diagnosis often embraces such health education and promotional activity which may be far more valuable and cost-effective than treatment. I do not understand the argument that it is legitimate to charge for curative medicine, but illegitimate to charge for preventive medicine.
My hon. Friends underestimate the willingness of many people who visit the dentist, whose incomes have risen over the past nine years and whose taxes have been reduced, to make some contribution towards that service, especially if that contribution in turn goes back to funding its expansion. I do not feel in the least apologetic or defensive about this. I am happy to defend the measure in my constituency, and I shall vote against the Lords amendment tonight.

Mr. Fearn: I wish to speak against the Government's amendment and in favour of Lords amendment No. 20.
Each day that I appear in Parliament, each day that goes by, I find it more and more incredible that the Government get away with introducing legislation that flies in the face of all expert advice and public opinion. With the exception of a few members of the Government, I do not know anyone or anybody connected with the dental or medical profession who supports the introduction of charges for dental checks. Yet the Secretary of State seems hell bent on getting the clause on to the statute book, even though the measure contradicts the Government's professed objectives.
The thrust of the White Paper "Promoting Better Health", so the Government would have us believe, was, as the title suggests, the promotion of preventive medicine to improve the health of individuals. Indeed, one of the paper's stated aims was to achieve the wider availability of dental treatment. But when the Bill was presented to the House, we found that the Government had, by one fell stroke, reduced the availability of dental treatment to many of the population by introducing a charge for dental checks.
When the deterrent argument was put forward previously, the Government responded by saying that as the charge would be only £3·15 it would not act as a deterrent. My answer to such callousness is that whoever makes such statements has obviously never had to count the pennies on a Monday morning to see whether there is enough to cover the cost of sending the children to school on the bus or enough even to buy them a lunch when they get there. He has obviously never had to count his pension pittance to decide whether he should have meat for the day's meal or put an extra 50p in the meter.

Mr. John Marshall: The hon. Gentleman refers to £3·15 as a deterrent. Is he aware that gross average earnings are £224 a week and £3·15 is less than 2 per cent. of that?

Mr. Fearn: I am aware of most incomes, but I do know about the incomes of the poorer people, which the hon. Gentleman may not know about.
It is no good someone saying to me that there is a safety net to cover such cases, because it is quite clear that many people do not take up state benefits. That is not surprising when one sees the length of the forms that have to be filled in and the number of questions to be answered. I think that 17 pages is the latest figure. Most important of all is the stigma attached to such benefits. Therefore, it is not surprising that people do not apply for them.
Another factor in the cost of dental charges is that if and when the measure is introduced the cost may be only small at first, but if we look at prescription charges over the past 10 years, we all know that if the Government have

anything to do with it, it will not be long before the charges are increased to a rate way above inflation. Charges for dental checks, whatever they cost, are contrary to good preventive medicine.
The Government admit that there has been a great improvement in the dental health of the British people, including those in Scotland, who in the past had a poor dental health record. Much of that success is due to preventive measures. Regular check-ups play an important part in that process. Any action that reduces them can only be a step backwards.
It is well documented that dental checks play an important role in the early detection of life-threatening diseases such as oral cancer. Not so well known is the role that they play in the detection of other diseases, as the experience of one of my constituents highlights. A few years ago, after going from one specialist to another and undergoing tests for cancer, tuberculosis and many other conditions, and weighing only six stones, she visited her dentist for a check-up. He promptly sent her back to her doctor with a suggestion that she was suffering from an over-active thyroid. His diagnosis proved to be correct. We should look to the diagnoses of dentists to give patients the chance to live.
Are we really to run the risk of allowing the detection of many diseases to fall by the wayside and in doing so add to the costs of the NHS? It is clear that if the House does not support Lords amendment No. 20 today a significant number of people, not just the very poor, will be deterred from visiting their dentist until it is too late.
In the short term, it is possible that this clause will save the NHS a little money, but in the long term it will prove to be far more expensive, as dentists and doctors are required to treat conditions that, if detected earlier, would have been easier to treat and cure. The repercussions from the introduction of dental charges on the health of individuals and on the Health Service cannot and must not be underestimated.

7 pm

Mr. Michael Colvin: I shall be brief because I appreciate that it is in the Government's interest that this debate should go on as long as possible. I congratulate my right hon. and learned Friend the Secretary of State on proposing his amendment in what I may describe as his characteristically robust style. When he hitches up his trousers, we all know that he is going to sock it to us. However, I think that he has got it wrong. I believe that right hon. and hon. Members would find great support for their Lordships outside this Chamber. There is a danger that if we were to resist the Lords amendment and returned the clause to their Lordships, they might amend it once more, and we would embark upon the kind of parliamentary ping pong that could eventually lead to a constitutional crisis.
I wholeheartedly support the Bill, which follows the White Paper on primary health care, "Promoting Better Heath". Among the White Paper's four objectives that are to be enshrined in the Bill are the promotion of health, the prevention of illness, and the importance of getting value for money. I feel sure that Members on both sides of the House wholeheartedly agree with those objectives.
Those parts of the Government's strategy have my wholehearted support. The Government have already demonstrated their commitment to primary health care by


spending £5 billion per annum for that purpose, in preventing disease. The hon. Member for Livingston (Mr. Cook) commented that the White Paper makes no mention of charges, but I draw the attention of the House to the Conservative manifesto for the last general election, which was not all that long ago, which also made no mention of them.
I believe that the House is puzzled by two Government inconsistencies. First, the Government are inconsistent in introducing eye and dental inspection charges when so many other examinations remain free of charge. Two of my hon. Friends mentioned breast screening and cervical smear tests, which are free. Why is that so? If one is to be consistent, charges should he imposed for all tests. Secondly, the Government are inconsistent in demonstrating their belief in preventive medicine while at the same time proposing measures that will harm prevention and increase the number of people needing to be cured.
The Government have tried this before, in 1980, when my hon. Friend the Member for Reading, East (Sir G. Vaughan) was the Minister of Health, and when the Government attempted to introduce eye inspection charges. On that occasion, my hon. Friend accepted that my hon. Friends the Members for Birmingham, Edgbaston (Dame J. Knight) and for Woodspring (Sir P. Dean) were strongly opposed to the Government's proposals. My hon. Friend the Member for Reading, East acknowledged that it was a very important matter. He said:
In no way do we wish to create a deterrent for people seeking eye testing who need treatment.
He went on to say:
It is characteristic of this Government"—
and he was speaking then of a Conservative Government also—
and of our democratic process, that when strong representations are made to us we are only too willing to consider them carefully … It is not our intention to proceed with charges for sight testing."—[Official Report, 15 May 1980; Vol. 984, c. 1781–82.]
If that was good enough then, it is good enough now. What has changed? There have been a few changes. One of the opponents then is now a Dame, and another has become Deputy Speaker. The Minister at the time is now a so-called rebel. Another fundamental change is that today's economy is much stronger than it was in 1980. However, if one accepts my right hon. and learned Friend's proposition that the Government are trying to save money for the National Health Service, which I do not, surely the argument for maintaining free tests is far stronger today than it was in 1980. Why did the Government accept the proposition that tests should be free in 1980 but are trying to impose charges now?
In this debate on dental charges—and the same is true in respect of eye testing—both sides base their arguments on presumption. The Government presume that charges will not deter, and that, in the case of dental inspections, about £50 million a year will be saved, whereas the so-called rebels presume that charges will act as a deterrent that will in the long run cost the Health Service much more in patient treatment than will be saved in the short term.
The Government have got it wrong. There is reasonable doubt on both sides. We are not debating something inanimate but are considering our constituents' health and the prevention of what can be serious diseases. It is a matter of life and death, and we do not dice with death. My right hon. and learned Friend should not do so either.

In the face of any reasonable doubt, tests must remain free of charge. That proposition is supported not only by the specialist organisations concerned with both dental and eyesight but also by the BMA and the British Dental Association.
The BDA maintains that, if there is any doubt, tests should remain free of charge. It points to two vulnerable groups—the young and the elderly. Until 1981, no charges were made for NHS dental treatment to those aged under 21, with the exception of denture charges, which were rarely relevant but were imposed from the age of 16. After April 1981, charges applied from the age of 18, except for patients in full-time education, when they began at 19 years of age. That brought about a short, sharp drop in treatment provision in the age group concerned. So paying does deter.
As to the elderly, I may point out that about half of all oral cancers are found among those aged 65 and over. Additionally, the risk of death from oral cancer is even greater than it is from cervical cancer, for which tests are still free.
I cannot be described by any of my right hon. or hon. Friends as a Tory wet, and nor can many of my hon. Friends who signed early-day motion 1405 and who I hope will be joining me in the Lobby tonight to vote against this proposition. We oppose the imposition of charges because we want to save money for the Health Service.
Once I was unwise enough to suggest in this Chamber that a politician's mind is determined by the state of his seat. I was told to withdraw such an offensive generalisation, but it seemed to make sense to me that before going into the Lobby to vote against the Government I should find out what my constituents had to say.
About 10 days ago, there was a meeting of my constituency Conservative Association executive, which had a heated debate on this matter. There were about 50 people present, and at the end two of them decided that there should be charges for everything, and that there should be means testing. Everyone else who was present supported me. That was not done out of loyalty to me but because they felt it was sensible to maintain free dental and eye tests. Last Friday, I attended a social event at one of my branches, in a place called Braishfield, when about 150 people were present. I would describe them as fairly well heeled and the kind of people who would probably anyway pay for their dental and eye tests. They too were solidly with me.
If that were not enough, on leaving Conservative Central Office the other day, I was hailed by a senior lady official who shouted "Charges!" at me. Memories of the military assault course immediately flooded back. When I turned to her, she added, "Dental and eye tests." I asked her what she meant and she replied, "The Tory women are behind you." I can think of better places to put the Tory women—[HON. MEMBERS: "Oh!"] If they believe that dental and eye tests should remain free, we should thank them for their support. I only regret that they cannot be with us in the No Lobby tonight. I call on my hon. Friends and on Opposition Members who feel that getting better value for the National Health Service is important, and who agree with the contention that prevention is better than cure, to support me in the Lobby tonight and oppose the Government.

Dr. Moonie: I listened with some puzzlement to the Secretary of State, who is after all one of the more intelligent Ministers and is renowned for his oratorical skill and his intellect. If we think about his intellect for a moment, we can admire the skill with which he left the Department of Trade and Industry ahead of the Barlow Clowes affair.

Mr. Robin Cook: And the Royal Ordnance factories.

Dr. Moonie: And the Royal Ordnance factories, as my hon. Friend reminds me. But we might find it a little puzzling that the right hon. and learned Gentleman has managed to walk into this can of worms—if the House will forgive the mixed metaphor.
I feel that we should cut through some of the more flatulent rhetoric that we have heard and try to get to the nub of the problem. There must be few hon. Members in the Chamber who seriously believe that the future of the Health Service over the next year depends on whether we introduce charges for tooth and eye examinations. That is nonsense.

Mr. Neil Hamilton: That is not the argument.

Dr. Moonie: The hon. Gentleman may say that, but it is the argument that the Secretary of State used in a direct threat to his Back Benchers.

Mr. Neil Hamilton: rose—

Dr. Moonie: No, I shall not give way. I do not intend to waste my time or that of the House. The hon. Gentleman can make his own speech if he wants to. That ought to clear the Chamber.
We saw the same spectacle last year. The right hon. and learned Gentleman's predecessor appeared before the House in October and told us that there was nothing wrong with the NHS and that no money would be forthcoming. What happened six weeks later? Back he came, tail beween his legs, and, lo and behold, the Treasury had found the extra money needed to keep the Health Service afloat for that year. It is absolute nonsense for the right hon. and learned Gentleman to suggest that, were the £49 million that will supposedly be saved by this measure to be lost to the NHS, it would not be replaced if it was needed. Of course it would be, and the right hon. and learned Gentleman knows that fine as well.
I shall confine my remarks to the role of prevention in our society's health. It is a subject on which I have touched before and, sadly, will have to touch frequently in the coming years. Last week in the Palace of Westminster we held an inaugural meeting for the Public Health Alliance. More than 100 people from all professions turned up, as well as lay people interested in public health—people who fear that we have lost our way in preventive medicine over the past few years, and who intend to try to do something about it. It might well be appropriate to mention the Secretary of State when we talk about people who have lost their way.

Mrs. Currie: Drinking and smoking.

Dr. Moonie: I think that remarks about smoking and drinking should be aimed at the Secretary of State rather than me. No doubt they frequently are.
We were worried about the development of public health in this country. What have the Government contributed? Last week we heard of the disgraceful

freezing of child benefit yet again, and now these proposals are before us. While other people are trying to reawaken our concern for public health, the Government appear to be doing their best to destroy it.
It is easy for us to forget how much we owe to public health measures, as opposed to those that members of my profession tend to claim as their own. Most are outwith our knowledge and are gradual factors that appear over the years. For example, the development of adequate sewerage and water supplies in the 19th century laid the foundation for health in our cities, and abolished cholera in this country many decades before it was abolished in other similar western countries.
In the 20th century, we have seen the advances made in the provision of school meals, school medical services, immunisation for children and many other measures that have contributed to improvements in public health over the past 100 years. Better wages and conditions over 20 or 30 years reduced deaths from tuberculosis from over 100,000 a year to almost nil.
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Sad to say, the Government remain to be convinced of the value of those methods. I shall not talk about cancer screening, as other hon. Members have referred to it. But if we are introducing an adequate screening service which we hope will reduce mortality from cervical cancer in particular, there is—as others have said—no logic in failing to charge for that as well, as the Government seem to think that charging has no effect.

Mrs. Teresa Gorman: Will the hon. Gentleman give way?

Dr. Moonie: No, I will not. I am mindful that hon. Members have been asked to limit the length of their contributions, and I do not wish to waste the House's time. [Interruption.] I look forward with great interest to the deeply intellectual contribution of the hon. Member for Tatton (Mr. Hamilton). I cannot think of anything worthwhile that he has said in the past, but perhaps tonight he will break the trend of a lifetime. [Interruption.] That is something foreign to the hon. Gentleman, but the longer that Tory Members are in the House the more they live and learn.
Child benefit has been cut in real terms by the failure to uprate. As the Black report said in 1980, by increasing child benefit the Government could immediately make the most important contribution that any Government could make to improving the health of mothers and children. Unfortunately, it was ignored by the Minister of the time, and it has been ignored by Ministers today. Let us remember the effect of that failure. The child of an unskilled labourer is still more than eight times as likely to die before reaching adulthood as is the child of a professional person such as myself. That is what we mean when we talk about preventive medicine, and that is what the Government cannot escape.
No member of my profession, the dental profession or any other profession would say that the charges will not have a deterrent effect—none, at least, whose views are worth listening to. I have heard both from their associations and from them in person, and I have had scores of letters from my constituents and others. Not even the Department's chief medical officer supports the


Secretary of State's contention, and I am certain that in his heart of hearts the right hon. and learned Gentleman does not support it either.
This is not just a matter of dental hygiene or of retaining our teeth. There is no doubt that the development of serious conditions, particularly oral cancer, can be prevented through early diagnosis. Oral cancer, for those who have not seen anyone suffering from it, is one of the most hideous ways of dying imaginable. It was described to me as such by a consultant over 20 years ago when I had my first lecture in ear, nose and throat medicine. I saw the patients in his ward, and I have seen the effects of the disease, which still kills the vast majority of those who get it—largely through the lack of adequate measures to arrest it before too late. This measure will enhance the risks.
The Secretary of State says that 38 per cent. of people will he exempt from charges. Many of those are people who will not take up family credit—the 70 per cent. who are missing out on benefit and who will likewise miss out on their exemption from charges, either because they are ignorant of it or, as in the vast majority of cases, because they are too proud to pay for the health that they ought to have as of right.
I, for one, have no objection to paying more in taxes to ensure that these services remain free for everyone regardless of their means, and I trust that enough Conservative Members will support us in the Division to defeat the Government.

Mr. Michael Morris: The logic of the argument of the hon. Member for Kirkcaldy (Dr. Moonie) is that we should have no prescription charges—[Interruption.]—but of course a Labour Government introduced prescription charges in 1949. We all know that we need prescription charges to provide some revenue for the Health Service and to ensure that medicines are valued as medicines and not treated in a frivolous manner.
We owe thanks to my right hon. and learned Friend the Secretary of State for Health and his team today. They have brought before the House the largest ever increase for the National Health Service. With that £2,000 million we can begin to make progress. My right hon. and learned Friend is right to ask whether an extra £49 million matters in a sum as large as £2,000 million. I suggest that it does matter. By any yardstick £49 million is a lot of money. There are about 200 district health authorities in the country, and that £49 million represents about £250,000 for my district.
If we consider dentistry in Northampton, that £250,000 which, roughly speaking, represents the revenue from the charges paid by the 50 per cent. of people who go to the dentist, would more than fund the orthodontic unit for which we have been waiting. If there were a poll in Northampton on whether people should spend £3·15 on a dental check-up and that money should be used to set up an orthodontic surgery unit in the Northampton general hospital, I am prepared to wager that the majority of people in my constituency would want the money to be invested in oral surgery.
It is helpful of the British Dental Association to arm us all with figures. Those figures clearly show that since the charges for courses of treatment have risen dramatically, there has been an increase in uptake among the elderly. In 1968, 27 per cent. of people were having courses of

treatment. The latest figures from the British Dental Association show that the uptake has risen to 45 per cent. Despite increased costs, the elderly use the service.
My hon. Friend the Member for Ealing, Acton (Sir G. Young) was quite right. Those who turn up at the dentist expect to pay for a course of treatment. They know that a course of treatment will cost more than £2 or £3. It will be a significant sum. The real challenge is not the £3 charge, but how to get the other 50 per cent. of the nation to have any sort of check-up. I hope that my right hon. and learned Friend will pick up the point raised by my hon. Friend.
I am quite sure that my right hon. and learned Friend is absolutely right to apply the charge. I want the money to be reinvested in an orthodontic unit in Northampton general hospital.

Mrs. Rosie Barnes: According to the Chancellor, the economy is thriving. Today, he has announced increased funding in a number of key areas.
The health and well-being of our citizens must be a priority for any Government. It makes sense economically, politically and morally. If the Government are committed to primary health care and preventive medicine, why are they taking the illogical and counter-productive step of introducing charges for basic examinations which have always been free in the past? The poorer members of society—those just above the level of eligibility For exemption—will not come forward and they will certainly suffer. Charges will be a disincentive and will reduce take-up.
A real commitment to preventive medicine and primary care would mean more rather than less free screening. We are eroding the principle of the National Health Service free at the point of use. We should be prepared to pay for the National Health Service, but we should pay for it through taxation. Those of us who are better off are prepared to pay more at that stage to maintain the principle of the National Health Service being free at the point of use.
Why have the Government singled out specific tests on eyes and teeth? Are opticians and dentists considered to be the fat cats of the medical profession? Is it thought that they can absorb such costs? It will not happen. The Royal National Institute for the Blind has carried out a survey which shows that it will cost £10 for eye tests and £3·15 for dental tests. Are we to assume that eyes and teeth are optional extras—a cosmetic area that does not involve life and death as much as other areas do? What about hearing tests, cervical smears, breast screening, routine tests in pregnancy, and blood tests? Will those all suffer the same fate? What is the principle that sets those two tests apart from the rest? I do not understand it.
It seems to be a miserly act. We are talking about 40 per cent. exemption, but we are contemplating a huge bureaucracy and administrative cost to ascertain who should pay charges and who should not. It seems very silly that, if the money is available to invest further in the Health Service, we should start charging for vital tests. Where will it end?
The principle of the National Health Service being free at the point of use is vital arid must be defended tonight. Yes, we must pay, but we should pay through taxation and not when we need medical care.

Sir Gerard Vaughan: I very much regret having to disagree with my right hon. and learned Friend's


arguments in this matter, especially on a day when he has raised such very large sums for the National Health Service, which we all know are much needed. We know that from our waiting lists and ward closures. I congratulate him on that. He put forward a very persuasive argument. That is not surprising when one considers that he is a distinguished barrister. His argument was entirely about money. He did not really refer to the other important issues.
If eye and dental tests were simply tests for spectacles or for holes in teeth, I would agree with him. I see no reason why people who can afford to pay should not contribute to the cost of the National Health Service through a charge. But, as we all know, there is another side to the argument which was touched on by the hon. Member for Greenwich (Mrs. Barnes)—the case for preventive medicine.
I have to tell my right hon. and learned Friend that times have changed, and people are looking for more and more health screening and preventive care. They have got the message that the Government have been putting forward that people should have their health checked regularly. My right hon. and learned Friend is promoting that message and I wish him success. The more people go for health checks the sooner disease can be detected. So we come to the curious situation in which breast screening, cervical screening, blood pressure checks, blood cholesterol tests, diabetes tests and a whole range of other things are all free. When it comes to having one's eyes examined, which is not the same as being measured for spectacles, and having one's mouth examined, which is not necessarily the same as looking for holes in teeth, people will be charged. Such examinations are valuable for the early detection of disease. My right hon. and learned Friend never referred to that—that is why I disagree with him so strongly.
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If we are to maintain a National Health Service which is free at the point of need, we should include screening for health care. Others have spoken about oral cancer, but there are more than 200 illnesses or conditions which can be diagnosed by examining the mouth. Even more important conditions can be detected by examining somebody's eyes. We use our eyes to look out on the world, but they also provide a means of looking into the body. Although often referred to in another way, I am basically a neurologist and I have detected early brain tumours where there is papilloedema or pressure on the back of the eye, and early diabetes. A colleague in the House told me recently that his wife had been diagnosed as having a high cholesterol level when she went to have her spectacles checked.
We are opening up preventive medicine, so even if my right hon. and learned Friend wins the Division tonight, can he not come up to date and provide a comprehensive health screening service which can detect disease early on? It would save money in the long run, not cost extra. My right hon. and learned Friend looks as though he disagrees, but he is a barrister. I am a doctor. I resent being told that eye examinations and mouth examinations—I am not calling them dental checks—are not important in health care for our community. I hope that my right hon.

and learned Friend will have the courage to say, "I have made a mistake and I shall let the Lords amendment stand."

Dame Jill Knight: Can I ask my hon. Friend about some information that I received recently? I was told that dentists frequently discover oral cancer and are able to deal with it and that they know that it is more common than cervical cancer. If there is to be a charge for checking whether there is a cancer in the mouth, is there to be no charge for checking the presence of a cancer in another part of the body?

Sir Gerard Vaughan: My hon. Friend has drawn attention to one of the anomalies and inconsistencies in the Government's stance. It is absolutely ludicrous to charge for inspections at one end of the body but not at the other. It is ludicrous, for example, to have free urine tests for diabetes but to charge for eye examinations which may discover diabetes.
I am aware that many others wish to speak and I think that I have made my point. This is an illogical and out-of-date proposal and I hope that the Government will think again.

Mr. David Hinchliffe: I have followed the Bill throughout and served on the Standing Committee, but I am amazed that the Government have offered no defence for what they are pushing through. I am all the more amazed in view of the Chancellor's statement today, as he more or less claimed that the Exchequer has never had it so good. Nevertheless, he desperately needs what the Secretary of State called peanuts, which would be made available as a result of the proposed charges. The Prime Minister's statement today also astonished me. She said that people will be put out if they are not allowed to pay for check-ups.
The hon. Member for Northampton, South (Mr. Morris) said that people are upset because they cannot pay for their bypass operations, tonsilectomies, or hip replacements. I have not had sacks full of mail on that issue, but I have had a vast quantity of mail from people who deeply resent the Government's policies on this issue. The Prime Minister scraped the very bottom of her barrel when she spoke of people being offended by not being able to pay. That comment was greeted with derision, even on her own Back Benches.
I commend Conservative Members who are standing out against the Government on this issue. Their sincerity is not in doubt. It is important to highlight the fact that there is a significant difference between the stance of Tory rebels and that of the Labour Opposition. The Tory rebels see the Government's stance in terms of the damage that will be done to preventive health care just to generate relatively small revenue for the NHS. I listened in Committee to the hon. Member for Harlow (Mr. Hayes), who spoke fluently and sincerely. I do not doubt the correctness of the stance that he took in Committee. The Tory rebels are right—the Government have failed to provide a scrap of evidence which has medical backing in support of what they are doing.
The Opposition agree with the Tory rebels, but we also see the change as part of a wider process of moving from state provision of a National Health Service to a system based on the purchase and sale of health care. That is crucial to an understanding of why the Government are refusing to bow to the reasonable arguments being


advanced by Conservative Members. The issue must be seen in the context of much wider developments in the NHS.
The Government have encouraged the belief that we cannot afford a National Health Service. We are frequently told that there are too many old people, that people are living longer, that the NHS is a bottomless pit and that expectations are too high. Health Ministers have also tried to create an expectation of paying for health care. How else are we to explain prescription charges shooting through the roof in spite of the Government's arguments as presented in the Tory manifestos of 1979 and since? I am deeply offended when I see people in my surgeries who take it for granted that they have to bribe consultants to gain access to the basic health care to which they are entitled and for which they have paid for many years.
These proposals can be understood only in terms of the Government's ideological hatred of the central principles that underpin the NHS. They regard the NHS as the last bastion of collective provision which must be dismantled by the thrust of Thatcherism. They regard it as a barrier to total freedom from the state, and as a barrier to American-style health care as a business and an enterprise.
I believe that charges for dental and eyesight checks are a calculated step towards the establishment of a health care market. The Bill is yet another nail in the NHS's coffin. That being so, I strongly urge those who believe in the NHS to support the Lords amendment.

Mr. John Greenway: There has been perhaps more emotion in the debates on this issue than on any other issue so far in this Parliament. The Government's case is more credible than has been portrayed in the media and in previous debates. It has been strongly argued that examination charges will seriously deter people from regular attendance, to the detriment of patients, and that those who are deterred will suffer adverse consequences. I am not convinced that that will happen. Such evidence as exists is inclined to support the opposite point of view.
As the House will recall from earlier debates, for more than 15 years—

Mr. Dennis Canavan: On a point of order, Madam Deputy Speaker. That man is reading every word of his speech, which has obviously been written by some party or Government hack.

Madam Deputy Speaker (Miss Betty Boothroyd): That is not a point of order for the Chair.

Mr. Canavan: Further to the point of order, Madam Deputy Speaker. There is a rule of the House that one is not permitted to read a speech. That man is reading a speech.

Madam Deputy Speaker: I am sure that the hon. Member for Ryedale (Mr. Greenway) is referring to his notes copiously.

Mr. Greenway: Thank you, Madam Deputy Speaker. Had the hon. Member for Falkirk, West (Mr. Canavan) waited a moment longer, he would have heard me say that, for the past 15 or 16 years, I have run a business advising general dental practitioners on the management of their practices, so, without any question, all the words that

shall say will be words that I have written, including those in the many speeches that I have made to dental meetings throughout the country for the past 15 or 16 years.
I have observed many changes in the general dental service. There has been a dramatic improvement in dental health. Let us get one thing clear: the dedication and application of general dental practitioners have been major contributory factors in the improvement in the nation's dental health. Other factors are also evident. There has been a general increased awareness by the public of the need for self-care and oral hygiene. The use of fluoride, largely in toothpaste but also in water supplies, and more sensible diet, with a lower sugar intake, has reduced tooth decay. Despite that, 50 per cent. or more of the public do not regularly visit a dentist. In the latest issue of the British Dental Journal, one of the new regional advisers in general dental practice wrote:
Let's call It 'Dental Consultation."'
He said:
dentists should be asking themselves why around 26 million people in the UK do not share the profession's perception of need for regular dental care.
Can it be that people do not attend a dentist more frequently because of the low priority they give dental treatment and regular dental attendance? Cost is cited by opponents of the new charge as a major deterrent. "People cannot afford it," they say. I do not accept that. We have already heard an announcement by my right hon. and learned Friend the Secretary of State about exemptions, so those who are poor and at the bottom end of the income scale will get help and will not have to pay. As my right hon. and learned Friend said, that number was increased only last week.
Those who argue costs as a deterrent really mean that there are many who would rather spend their money on something else. That is true, especially of the young. My right hon. and learned Friend will recall that I wrote to him about four weeks ago and suggested that, if there is to be any change in the Government's thinking, perhaps we should reconsider the position of young adults. It is clear already from this debate that some hon. Members are persuaded by that view. Whatever we decide tonight, that is a matter to which we may have to return.
Anyone who travels regularly on trains will see 19, 20, 21 and 22-year-olds consume at least £3·15 worth of beer apiece between King's Cross and York and, I dare say, other destinations as well.

Mr. Harry Barnes: Not in second class.

Mr. Greenway: It is mostly in second class.
The opponents of these modest charges seem to have concluded that the priorities of some, if not all, patients are so irresponsible that they will present themselves for dental examination only if it is free. Are we really saying that the public's appreciation of the need and value of a regular dental consultation is so pathetically low that we must not require a modest charge from those who can afford it? What an inverted sense of proportion among people—mostly on the Opposition Benches, but also, sad to say, some Conservative Members—who say one minute that a regular dental check is a potentially life-saving necessity, yet in the next breath say that it can be done only if we provide it free of charge. Nothing is more certain to undermine the real value of a service or benefit than free universal provision.
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It is an incontrovertible fact that, over the past 15 years, dental charges, which were started by the Labour party, have improved the efficiency and standard of the general dental service. Patients have more consumer awareness. The same is true of optical care. Extending charges to include dental examinations will present a major challenge to the profession and the Government to ensure that the public give dentistry the priority that it deserves.
Priority is what the debate should be about—increasing priority and awareness of the need for regular dental attendance, especially among the 26 million people who do not now attend. The majority would get free treatment as well as a free dental examination. It will be a shocking indictment of every one of us who is concerned with this matter—not just the patients but the profession, family practitioner committees, the Department, the Government Front Bench and us politicians—if these modest charges prove a barrier to dental attendance.
The White Paper promised that the Government would support a campaign for the promotion of general dental health. Let us get on with it soon. Although I do not accept the argument that charges should be a deterrent, that is not to say that helping patients to avoid high charges and to meet their obligations does not have merit. The first way to avoid high charges is to attend a dentist regularly. The examination charge, which we are debating, is part of an overall strategy of proportional charges under which regular attenders will pay no more than under the old system. That is a fact.
Dental insurance has a role to play. I am talking not about private dental insurance but about the member companies of the British Health Care Association, which provides schemes so that their members can insure, at a modest amount, to receive cash benefits when they have to pay a charge for dentistry or for optical work or if they are in hospital. Last year, British Health Care Association members paid about £7·5 million in cash benefits to members for dental treatment. That is only 2·5 per cent. of the amount raised from patient charges. Clearly, there is plenty of scope. Most members of these schemes are encouraged to join them by their employers. Employers can play a role in ensuring that they take a lead and that their employees have the benefit of such schemes.
The issue goes much further than the examination charge. I should like to refer to three other matters. First, there is the overwhelming need for a restructuring of the general dental service and the way in which dental practitioners are remunerated. As with so many other facets of our NHS, the present system was established 40 years ago. Then the profession had little time to do more than repair the effects of neglect. Indeed, GDPs did so well financially that fees were cut. Even 10 years ago, dentists were keen to absorb every new technique to improve output and meet demand. All that has largely changed. Now practitioners increasingly find that their regular patients require little, if any, dental treatment. One of my hon. Friends said some 8 million of the 37 million courses of treatment are examine and report only.
Since the debate about charges began a year ago, the fee paid to a dentist for an examination has increased from £3·90 to £4·20, the £3·15 that patients will be asked to pay being 75 per cent. of that. If the practitioner is required to

screen for so many different illnesses, why is he so appallingly badly remunerated for doing so? It is because the present structure assumes that he will find that a great deal of treatment is required, but increasingly that is not the case. We must embark on urgent negotiations about that matter. I am disappointed that a year has passed since I made that request in the House and we seem to have got no further because we have been distracted by the argument about free examinations. We must have a continuing fair contract to reward the proper relationship between general dental practitioners and their patients and to reward good conservative treatment which lasts. Let us get on with that.
Secondly, there is the question of resources. If the charges were not accompanied by a major commitment of extra resources such as that my right hon. Friend the Chancellor announced today, there might be grounds for opposing the charges. Some dentists have suggested that the Government are abandoning the general dental service, but that is not true. Some hon. Members may be surprised to learn that in the past three years the net pay of general dental practitioners has been increased by almost a quarter and the fees paid on their item of service scale by one third—three times the rate of general inflation.
The Government's commitment does not end there. This year's fee scale already incorporates some of the measures outlined in the White Paper. My hon. Friend the Member for Portsmouth, North (Mr. Griffiths) asked about this earlier. I can tell him that there are already pilot schemes to redistribute dentists more evenly throughout the country. There is one scheme in Walsall and three in the north-east. There are also changes in the prior approval rules to give practitioners more control over their clinical judgments and the treatment that they give. That, too, is incorporated in this year's fee scale. There is also more funding for postgraduate vocational training. The findings of the Windermere relativities inquiry have been incorporated straightaway. Some Opposition Members may not know what that means. Members of the profession decided how money should be redistributed across the fee scale to reflect the type of work being done in the National Health Service today, not that of 40 years ago.
I am sure that everyone in the House and throughout the country wants the Government to put more money into the Health Service to fund nurses' pay. That has been given proper priority. We now need to consider where the extra resources are going. Some district health authorities have achieved great efficiency in their operations, but they need more money. I want more money for Scarborough and for York. If voting for examination charges will help to achieve that, so much the better.
Thirdly, we should extend consumer choice to other parts of the NHS, perhaps to other areas of general practice as well as to the hospital service. Contrasting levels of efficiency between one district and another can no longer be tolerated in a society in which, despite record funding, resources must continually struggle to keep pace with technological change. If we want more resources, we must be willing to take unpopular decisions to achieve them without damaging the economy. It is understandable that Labour Members have the audacity to bite the hand that feeds them, but I urge Conservative colleagues in this House and in the other place not to interpret an unpopular decision as a wrong decision. With demands on the Health


Service often seemingly infinite, it is essential that resources are put to the best use and reasonable opportunities for raising revenue are maximised. That is the moral case in favour of charges. It is not a popular message, but it is a right and responsible one.

Rev. Martin Smyth: The Secretary of State made the point that this was a national health debate, and I was happy that he referred to Northern Ireland as well as to England, Scotland and Wales, because this national debate affects us all.
Much has been made of today's cash injection of £1·8 billion into the Health Service. The Select Committee said that £2 billion would be needed and was accused by the Department of plucking figures out of the air, so I welcome the fact that our assessment has been accepted. That assessment, however, was made earlier in the Session and did not cover further increases in wage settlements.
Coming to the nub of the debate, it was fascinating to hear the Minister suggest today that some of his Back-Bench colleagues had changed their minds since the House first voted on this. My profession is always happy when people change their minds, when they repent, come to their senses and go along the right road. I regret, however, that it seems that the Minister has backslidden as in an earlier incarnation he supported a free Health Service at the point of delivery and made much of that principle. I hope that those who realised that they were wrong a few months back will stick to their guns today and see us through this time. The comments of the hon. Member for Northampton, South (Mr. Morris) in relation to the point made by the hon. Member for Kirkcaldy (Dr. Moonie) were not in support of charges for consultation but defended the concept that there might be a ground for paying for services. In my judgment, that would cover prescriptions rather than charges for seeing the doctor before being told what one requires. We must stick together on that and ensure that the National Health Service is maintained on that basis.
To refer specifically to Northern Ireland, it has been argued that the charges will not deter anyone from consulting a dentist, optician, optometrist or ophthalmic surgeon, but I query that. If the Government are already spending money on PR campaigns to encourage people to take up social service benefits, I suspect that it will take a great deal more PR work to encourage people to go to the dentist or the optician with the argument that the charge is only a minimum amount.
A short time ago a colleague asked me why the charge was to be £3·15. He said, "Isn't that three guineas?" The secret has slipped out. Guineas are still used regularly for legal fees. Those who suggest that three guineas is not much should bear in mind that, although it may not be much for those in the legal profession, it means a lot to the people about whom we are concerned. It may be that the Government have discovered this as a way of cutting down waiting lists. With the rationalisation of health care delivery in Northern Ireland, ophthalmic work has been centralised, particularly in the Royal Victoria hospital, Belfast, with a unit at Altnagelvin to cover the north-west. That was an attempt to provide modern health care in a rational and financially disciplined way. In fact, the waiting lists are increasing because, instead of finances being directed to help that service, they are being curbed time and again.
8 pm
When considering this issue tonight we must deal with the question of the care of patients and the deliverance of that care. I share the experience of other hon. Members—and I cannot imagine that the Government have missed it—that modern care of patients can be enhanced by eye tests and dental checks. Therefore, although others may have changed their minds, my hon. Friends and I are even more confirmed in our opposition to the Government's proposals, which we shall oppose in the Lobby tonight.

Mr. John Maples: It must be especially galling for the Labour party to have this much-trailed debate on the very day on which my right hon. Friend the Chancellor of the Exchequer has announced additional funding for the NHS of £2 billion. At the time of the Budget, Opposition Members were saying that the 2p tax cut would have been far better spent on the Health Service. They now find that my right hon. Friend has succeeded in doing both, contrary to all their predictions. That must stick somewhat. I cannot help but think that, even if a Labour Secretary of State had had the option of another £40 million to spend, he would choose to spend it on removing the proposed charges. That £40 million, together with the £100 million for eye tests, can be used for so many other things. I cannot believe that even the hon. Member for Livingston (Mr. Cook) would choose to spend that money on removing charges for tests.
The argument against charges for the tests is the argument against all charges in the NHS, which after the implementation of the new charges will raise about £800 million or £900 million a year. If the Opposition were to follow the purity of their argument, the first additional £1 billion that they chose to spend on the Health Service would not buy one additional operation. I simply cannot believe that that is what they want.
The only really important consideration is whether the charges will act as a material deterrent to people having eye or dental checks. Whenever charges are introduced or increased, the Opposition claim that people's attendance will go down. That was said when dental charges were raised and, again, very vociferously when charges were introduced for glasses. The Opposition said that people would not have glasses and would crash into each other on motorways or walk into lamp posts. That has not happened. Instead, the number of eye tests and the number of prescriptions for lenses has risen but. as the Government predicted, the charges for glasses have gone down.
Figures for dentistry have been bandied about tonight. Charges have been increased every year since 1976, yet the number of courses of dental treatment has also risen every year since 1976. It is unlikely that the charges will prove a deterrent. After all, the low income groups and all children are exempt, so we are really discussing only the 60 per cent. of the population who form the wealthier groups. For them, £3 for a dental check and £10 for an eye test once a year is not a material sum that will deter them. I cannot believe that the reason why some people will not have checks is that they will have to pay. Although the tests are currently free, they know that if anything is wrong they will have to pay for treatment. That does not put them off. People sometimes do not go to the dentist until there is obviously something wrong or they do not go to an optician until they think that they need glasses. A £3 or a £10 charge will not act as a deterrent.
The weakness of the deterrent argument is given away in a lobbying circular that we have all received from the Federation of Ophthalmic and Dispensing Opticians. It states that
people will find the need to pay for a sight test a psychological, even if not a serious financial deterrent.
It demonstrates the weakness of the financial argument when the federation is thrown back on arguing a psychological deterrent.
The Opposition are, in effect, saying that the 60 per cent. in the wealthier groups are not sufficiently responsible to decide whether to go to the dentist or to have an eye test because they will have to pay £3 or £10. If that is the Opposition's opinion of the level of people's responsibility for their own affairs, it is amazing that they allow them to do anything on their own.
I believe that many sight tests will, in fact, still be free. When I drive to my constituency I go along the Walworth road and past the headquarters of the Labour party. Right on the border of the constituency of the hon. Member for Peckham (Ms. Harman) is a large shop, which was not there a few years ago. Perhaps when the hon. Member for Livingston is bored at an NEC meeting the hon. Lady could take him there as it is only 200 or 300 yards from the Labour party headquarters. The shop takes up two huge shop fronts and is called Betterspecs. It has a big sign in the window saying, "Free eye tests". I suspect that that will happen throughout much of the country.
If I am wrong about the deterrent argument, what will be the consequences? On the whole, they will not be that serious. If people are walking around wearing the wrong glasses, or if they do not have a tooth filled until it begins to ache, those are not really serious consequences. They are certainly not life threatening. One or two examples of possible serious consequences have been mentioned, such as glaucoma and oral cancer. We must remember that, when people have free eye or dental checks, it is not because they want to find out whether they have glaucoma or oral cancer. Those are accidental, random discoveries in the process of doing something else. A dental check is not a screening process for oral cancer; it is simply one of the by-products. I understand that the average dentist comes across only two cases of oral cancer during the whole of his career. If we want a screening process for oral cancer, that must be the most expensive and inefficient way of providing it.

Mr. Michael Carttiss: Does not my hon. Friend think that if two people discover that they have oral cancer that can be cured and that will save them a lifetime of disfigurement that is well worth the free checks? How can my hon. Friend calculate that in money terms?

Mr. Maples: Of course I understand that that is an awful disease, as is glaucoma. However, it is about time that my hon. Friend began to cost various elements of the NHS budget, because a cost can be put on all these matters. I repeat that if the only reason for a free dental check is to detect so few cases of oral cancer, it must be the most inefficient and expensive way of doing it that we could ever devise. I do not believe that charges would be a deterrent or that there would be dire consequencies. If, in the event, I am wrong and there is a huge increase in undetected glaucoma cases, that would be an argument for

heavily promoting the need for people to have their eyes tested occasionally to ensure that they are not contracting that disease.
Ever since tax-cutting Budgets were introduced, the Opposition have said that the public would prefer the money to be spent on the NHS. They say that the public are willing to spend enormous amounts on the NHS rather than have tax cuts. For a man on average earnings, the 2p tax cut in the last Budget is worth about £170 a year—£3·40 a week. Are we to believe that that same person is not prepared to spend £3 and £10 on dental and eye tests? Is a person willing to forgo all his income tax cuts so that the money can be spent on the NHS not to be trusted voluntarily, of his own free will, to spend £3 or £10 on dental and eye checks? That is an extremely patronising attitude. The inescapable conclusion that we must reach is that the Opposition think that the only good provision in society is that provided by the state and that no one can be trusted to do anything on his own.
The arguments of opponents of the proposal go to the root of the whole idea of charging in the National Health Service. If it is wrong to charge for dental checks and eye tests, it must be wrong to charge for other things. Charges, which come only from the wealthier 60 per cent. of the population, raise about £800 million a year. It cannot be sensible to spend an additional £800 million to absorb those charges back into the public purse when that money could be spent on buying so many other things for the Health Service.
When one considers that 60 per cent. of the population, it is worth remembering what has happened to their finances over the past 10 years. We know that the take-home pay of men on average earnings has risen by 29 per cent. a year over the past 10 years. The pay of those on half average earnings has risen by 22 per cent. and the pay of those on three quarters of average earnings has risen by 26 per cent. Those are substantial sums. Over the past 10 years, the take-home pay of a man on average earnings has increased by £2,400. For someone on three quarters of average earnings—about the level at which family credit runs out and at which the person becomes liable for charges—income has increased by £1,800 a year. The income of a person on half average earnings—about £120 a week—has increased by £1,100 a year.
The idea that people with those increased personal resources and increased individual wealth are not prepared to take some responsibility for paying minor charges towards health care is incredible in every sense of the word. If the increases continue, over the next 10 years, a person on average earnings will have an income of £5,000 or £6,000 more. It is surely a sensible proposition that out of that amount some marginal contribution should be made towards the cost of individual health care.
That is also the case for pensioners. Pensioners' incomes did not rise very much under the previous Labour Government. Since the Conservative Government came to power, pensions have risen quite a lot. The average pension has risen from about £100 a week in 1980 to about £135 a week in 1990—an increase of about 35 per cent. In view of that increase, it is reasonable to suggest that pensioners should make some contribution to their own health care and that they are able and willing to do so.

Mr. Frank Haynes: I wonder why the hon. Member, like many of his hon. Friends, referred to average earnings. I come from the mining industry and the phrase


"average earnings" there told a false story, which the hon. Gentleman is doing tonight—with respect. Half the men at the pit were in the top income bracket, but the other half —the lower-paid workers—received 50 per cent. less than that. What about the lower-paid workers? They are the people for whom we are fighting, and the hon. Gentleman should be fighting for them as well.

Mr. Maples: People on family credit, which is about three quarters of average earnings, will not have to pay for tests. No children will have to pay for tests. A person on three quarters of average earnings is £1,800 a year better off in terms of take-home pay than 10 years ago. People on lower incomes than that will probably be on family credit and will receive the benefit of free tests, as my right hon. Friend the Secretary of State has proposed. It is simply not true to say that I take no account of the lower paid. I did not need to bring them into the argument because they will be exempted from paying for dental or eye tests. It is only those who earn more than three quarters of average earnings who will be affected.
Most people are far richer than they were 10 years ago and are able and willing to pay modest charges towards items of health care. Charges will not be a deterrent to people seeking services. There must be better ways of spending £140 million than this one.

Mr. Keith Vaz: Yesterday afternoon, I led a delegation of pensioners from my constituency to meet the Prime Minister at No. 10 Downing street. We took her a giant pair of spectacles which measured 2ft 6in across, and a giant tooth. The more uncharitable among us might suggest that they were the right size for the Prime Minister in view of the size of her head and mouth. Of course, I am not that uncharitable. The reason why we took the spectacles and the tooth there was to show the Prime Minister the great concern felt by people in Leicester and, particularly, by pensioners about the proposed charges.
I was accompanied on the visit by Les George, aged 66, from Maplin road, Nethershall in Leicester. He remembers that when he was a young boy, the Labour Government introduced the National Health Service and that the National Health Service was free at the point of need. Irene Howell, aged 65, also accompanied us and, as we walked up to No. 10, she reminded us that had she not had a test, she might have lost the sight of one eye. Also with us was Mary Draycott, a young mother with two children, who has been campaigning hard for the decentralisation of health and dental services in the outer estates of Leicester. The delegation represented many pensioners in places such as Nethershall, Northfields, Evington, Thurnby Lodge and Belgrave, who are deeply concerned about the proposed charges.
Before I came into the Chamber this evening, I spoke to a constituent who came down from Leicester in a coach to present me with a letter, which I should like to read to the House. She writes:
I urge you to oppose and do all you can to oppose the proposals for the introduction of sight and dental charges. They will not improve the nation's eyesight or hearing. You may be able to eat with false teeth, walk with false legs but you cannot see with a false eye. Mrs. Thatcher is a wolf in sheep's clothing crying crocodile tears.

That letter came from a constituent who had never written to a Member of Parliament before, but who felt so outraged that she came all the way down from Leicester.
The charges are mean and vindictive. They are imposed by those who can afford to pay them.

Mr. Nicholas Bennett: That includes the hon. Gentleman.

Mr. Vaz: That is quite right. I have had three pay rises in the year and a half in which I have been a Member of Parliament, for which I did not have to bargain.
Many of my constituents and the constituents of my hon. and learned Friend the Member for Leicester, West (Mr. Janner) are unable to afford the charges. The experts in Leicester are united. The secretary of the family practitioner committee said:
During my career, three people have been operated on the day after I examined them and detected a blood clot or tumour.
General health will deteriorate because the chance to operate early will vanish and it could be too late by the time the patient notices the signs, then the treatment could be more complicated, dangerous and expensive.
More people will go blind as a result of less early detection which will cost more in the long run to care for them.
If the Minister tells me this evening that voting for health charges will mean that money can be invested in the health service in Leicester, let him come up with a number of assurances. The first assurance I seek is that the eight hospitals in Leicestershire that are about to be closed will not close. They include Ashby and district hospital, Catmose Vale hospital, Fielding Johnson hospital, Higham Grange, Roundhill maternity home, Regent hospital, Loughborough and Blaby hospital in the constituency of the Chancellor of the Exchequer. If the Minister assures me and my hon. Friends that people in Leicestershire, like Mrs. Broughton who is 87 years old, will not have to wait two years to have hearing aids made for them, that the current hospital waiting list of 8,500 will be cleared, that 200 people who are waiting for operations on the orthopaedic waiting list will be cleared off the list and that the Towers hospital which is under threat of closure will not close, we shall be tempted to listen to his arguments. It will take 60 days of full surgery lists to clear the cases that I have mentioned.
The Government say that they want a first-class service. We want a first-class Health Service. We do not want the jumble sale Health Service that we have at the moment, which means that hon. Members are invited to hospital fetes and charitable events to raise money for worthy causes such as the purchase of a kidney unit at Leicester general hospital.
Three weeks ago a number of my colleagues and I visited America. We visited an emergency room in a hospital. There, I witnessed a patient who had come in in great pain being asked, as the very first question, by the administrator: "Do you have insurance?" When he said that he did not, the patient, who was in great agony, was referred to the nearest public hospital, at which he no doubt had to wait because the public health service in America has been undermined to such a great extent. That is the kind of Health Service that the Government want, and the next Bill that comes before the House will provide for people to be charged when they visit their general practitioner. It already costs people in America £25 to see their GP.
I commend the hon. Member for Rutland and Melton (Mr. Latham)—another Leicestershire Member, and one with whom I do not agree on any other issue—on the stand that he has taken. This morning he declared on Radio Leicester that he would be voting against the charges. I urge all other Conservative Members to join the hon. Gentleman in taking that principled stand and to vote against the charges.

Mr. Churchill: I wholeheartedly repudiate the offensive remarks made by the hon. Member for Leicester, East (Mr. Vaz) about my right hon. Friend the Prime Minister. Such remarks do nothing to further the cause that he claims to support.
I warmly welcome the Chancellor's announcement that the Treasury coffers are awash with money and especially the news that an extra £2,000 million is to be made available for the Health Service in the coming year and a further £2,500 million in the year 1990–91. It is excellent news, and I applaud it.
I therefore find all the more regrettable and unnecessary the Government's determination to reverse the Lords amendment and for the first time to impose charges for eye and dental checks. I speak as one who is not known as a notorious wet.
The Government proclaim that they are in favour of preventive medicine. I welcome that commitment. Preventive medicine is not only right but it is the most cost-effective form of health care. Much more expensive treatments and hospitalisation further down the line may be required if preventive medicine does not exist or is inadequate.
There can be no doubt that over the years free eye and dental checks have made a significant contribution to preventive medicine. I firmly believe that to impose charges is as retrograde as it is unnecessary.

Mr. Bob Cryer: Hear, hear.

Mr. Churchill: I am obliged to the hon. Gentleman.
My right hon. and learned Friend the Secretary of State makes the perfectly fair point that I—and others as fortunate as I am—should not have free eye and dental checks. There is no earthly reason why I should. However, as I have told my right hon. and learned Friend the Secretary of State, neither I nor, I suspect, many others in my fortunate position have ever availed themselves of free eye and dental checks. It is a wholly bogus argument to say that, because the likes of Lord Hanson and Sir Ralph Halpern must be disbarred from going for free eye or dental checks, other people on earnings way below the average should be deprived of free tests.
I regret to have to say to my right hon. and learned Friend the Secretary of State—I am sorry that he cannot be in his place—that his belief that charges will not act as a deterrent is wholly unconvincing. If he is so sure that that is so, why in logic are not the Government moving to impose charges for breast cancer checks and cervical smears? There is no difference in logic between the two forms of screening.
I shall tell my right hon. and learned Friend why he is not moving in that direction. In his heart of hearts he knows that such charges would have a profoundly deterrent effect on those who need to be encouraged to go for regular checks. Regrettably, the present measure has

nothing to do with encouraging preventive medicine and everything to do with pressure from the Treasury. I acknowledge that the list of exemptions is sizeable; 38 per cent.—no fewer than 20 million of our fellow citizens—will be exempted. The key argument advanced by the Secretary of State in favour of imposing charges is that everybody who does not qualify for an exemption can well afford £3·15 for a dental check or £10 for an eye test in this increasingly prosperous Britain.
Is that really so? Let me cite the case of a constituent of mine who came to my advice bureau in Manchester only last weekend. He is in his late 50s. He lives alone. He is self-employed and his business has not been prospering. Last year he earned only £2,880. That works out at £57 a week net of tax, or one quarter of average earnings. After he has paid £23 a week in rent for his council house, now that his housing benefit has been reduced to only £1·23, he has no more than £25 a week of disposable income on which to live. Because he is in full-time employment, because he works more than 20 hours a week and because he is not a single parent, he does not qualify for income support. Therefore, he would be required to pay eye and dental charges under the proposal. Is it reasonable or right to expect an individual at the bottom end of the economic scale to pay such charges? He has only £3·50 a day on which to live—less than the Secretary of State is paying for his evening meal in the House. Is it reasonable to charge such a man £10 for an eye test? Of course it is not, and my right hon. and learned Friend knows that it is not.
Let me make a proposition to my hon. and learned Friend who is to wind up the debate. If he can tell me that my constituent, with less than £25 a week on which to live, will be exempt from the charges, I shall abandon my intention to vote against the Government and I shall join my hon. and learned Friend in the Lobby in support of the measure. However, I must tell him that the advice that I have received from the Secretary of State's private office, as well as from my local DHSS office, is that my constituent would not qualify, because he does not qualify for income support. On that basis, I have no hesitation whatever in saying that I shall oppose these objectionable and damaging measures not only on behalf of my constituent, but on behalf of thousands like him in constituencies throughout the country. It is no use brandishing averages, because we know how many are so high above the average, and it behoves us to pay attention also to those who are so far below the average and who are not caught by any safety net.
It gives me no pleasure whatever to vote against the Government, but I must say to my right hon. Friends that the Government are wrong in this matter, and they have lost the argument. They deserve to be defeated.

Mr. Roger King: After nearly three hours of debate, many arguments have been ranged for and against the amendment and many points have been made many times. Very little new can be said either for or against the amendment. However, I believe that the Lords amendment should be rejected, because the Government's proposals are constructive and will eventually filter through to an improvement in the National Health Service generally.
The crux of the issue is whether it is morally right or wrong to pay for a check-up of any kind. The distinction


between breast and cervical cancer tests and dental and optical check-ups is that the former are generally done at a hospital or by a general practitioner, but the optical and dental check-ups are done in semi-autonomous establishments on the fringe of the National Health Service. As we know, the optical testing side of the Health Service has been freed into a more competitive environment and that has filtered through to a more competitive product being provided. If the Lords amendment is rejected and the charges are allowed, we will see some competitiveness introduced into the market and eventually we will find that optical tests will cost very little and, perhaps, a good deal less than the £10 proposed.
Over the years the National Health Service has changed and people's perception of it has changed. When it was created in 1948, no one had any disposable income, and the National Health Service did not do a great deal more that repair broken bones and remove tonsils—[HON. MEMBERS: "Rubbish."]—in the early 1950s. Of course, it did a great deal more than that, but it was nowhere near as sophisticated as it is today, and the demands for treatment become ever higher as new expertise and techniques are developed which are ever more costly. Because of that, we must consider new ways of providing funding for the Health Service.
Our people have more disposable income and they are entitled to choose how they spend it. I do not believe that, because the majority of the population will be charged £3·15 for a dental check-up, they will not take the time or trouble to have that check-up. On the contrary, we have had well-documented evidence that as a result of some of the dental costs that have been passed on to the consumer more people are having dental treatment. Whether the connection is that, because one is paying for something, a value can be placed upon it, is open to conjecture. I believe that if a value is put on something, people are more likely to value the service that they receive.
It is encouraging that 40 per cent. of the population will not have to pay anything for their dental check-ups and 37 per cent. will not pay for optical tests. However, there are people who will be on the borderline. There will be areas that we will need to look at closely so that people are not disadvantaged in the way that my hon. Friend the Member for Davyhulme (Mr. Churchill) mentioned.
Some people feel that the NHS should be free at the point of use. Of course, NHS treatment is not free at the point of use to the extent that we might like, as some charges were introduced in 1976, and prescription charges have been with us on and off for some time. The emotive issue of treatment being free at the point of delivery is misplaced. I suppose that it could be said indirectly that if one is a BUPA subscriber, one's service is free in that one pays insurance and BUPA pays for one's treatment after it has been received. However, we do not describe BUPA as free at the point of service. The National Health Service treatment is not free, because we pay into a national insurance scheme, and we have paid heavily for it over the years.
I do not believe that it is correct for the Labour party to lecture us on treatment charges when, of course, in 1976 it was involved in implementing many charges. The hon. Member for Livingston (Mr. Cook) had the temerity to suggest that if we had a secret ballot everything would be greatly different. The Labour Government never had a secret ballot when they were in office in 1979 and decided to put up prescription rates. They never had a secret ballot

when they decided to cut the hospital building programme. They certainly did not have a secret ballot when they decided whether to cut pensions and so forth.

Mr. Robin Cook: The reason why the 1974 to 1979 Government did not hold secret ballots was that those of us who disagreed with them did not require a secret ballot in order to express our view. We had the courage to do so and did so regularly.

Mr. King: The evidence tonight shows that neither do we. We do not need a secret ballot to express our view. To suggest that we should have a secret ballot on this one issue when the evidence is that when Labour was last in office it was making unpalatable decisions and did not have a secret ballot is unfair.
Our Health Service will obviously become more complex as years go by. I believe that it is right to establish as a principle—as we have already done—that some contribution by the user where he can afford it is the way that it should develop. Wage rates have gone up by 9 per cent. in the last 12 months. If we add to that the tax cuts that were passed on to the population, we see that real disposable income is a great deal more because of the Government's economic policies.
I believe that what we are asking for is not unreasonable or unrealistic. The financial resources that will be released because of the extra income that will come into the Service will be of benefit to the Service generally. Because of the new money that will go a long way to improving the Service, together with what was announced in the Autumn Statement, the Government's proposal has my support.

Mr. Eddie Loyden: First, we should establish that the National Health Service brought in by the first post-war Labour Government made a dramatic change in the health care of the nation. I believe that every intrusion that is made by the Government in introducing charges for this, that and the other erodes day by day the National Health Service that was created in the early post-war years. I know that there will be hot denials from those on the Government Front Bench if I suggest that behind those charges and the Government's geneal attitude towards the Health Service there is a blatant ideological attitude that intends in time to dismantle what we know as the Health Service of this country.
People outside will not allow the Government to take away the great benefits that have flowed from the National Health Service. Shortly after the war people were given the opportunity to have access to free health care for the first time. Many were elderly people without teeth and who needed spectacles which they did not have. The National Health Service changed the whole nature of health care in this country. The first generation of post-war babies proved the value of the Health Service beyond any doubt.
Many of the comments made tonight by Conservative Members make it absolutely clear that this is not simply a question of charging for dental or optical testing. It is part of the continuing attack on the Health Service by those Conservative Members who want to see the end of the Health Service and who want to see it in the hands of the market because of the profits that can be made. They want only those who can afford health care to have health care. That was exactly the position before the founding of the Health Service.
Having grown up in a working-class area of Liverpool, I can tell the House of the many children who died in those cobbled streets because there was no Health Service. The child mortality rate in Liverpool was one of the highest in the country. Many of the afflictions suffered by working-class families were due to inadequate medical care, and, in some cases, to inadequate housing. Those afflictions led to the creation of the National Health Service.
It is a scandal that, having seen the benefits of the National Health Service, the Government make continuing attacks on it both in the House and outside. That is especially true of some of the Government's Back-Bench Members. Indeed, when listening to one Conservative Member, I wondered whether he was talking about Sainsburys or about the Health Service because he referred to "a better product". Where are we going when the Government's Back Benchers seek to bring the Health Service into the market? It is an absolute disgrace that hon. Members should talk about the Health Service in that way.
I happen to be one of those 250,000 people who have benefited from an eye test—

Mr. Deputy Speaker (Mr. Harold Walker): Order. Does the hon. Gentleman see the difficulty of the Chair? The debate has tended to go wider and wider in scope until it is now in danger of becoming a general debate on the Health Service. This debate is about dental charges. A later amendment deals specifically with optical charges. I understand that the hon. Gentleman wishes to speak to that. Therefore, I hope that he will not encroach too much on the subject of that amendment.

Mr. Loyden: With all due respect, Mr. Deputy Speaker, all aspects of testing have been spoken about tonight, including cervical cancer and oral testing.

Several Hon. Members: rose—

Mr. Deputy Speaker: Order. Mr. Loyden.

Mr. Loyden: I hope to illustrate the importance of those tests which at least some Conservative Members recognise.
8.45 pm
I happen to be one of the 250,000 people who, through an eye test, have been detected as having glaucoma. As most people know, glaucoma can—

Mr. Deputy Speaker: Order. I do not want to prevent the hon. Gentleman from making his speech, but I question whether this is the appropriate time.

Mr.Loyden: rose—

Mr. Deputy Speaker: Order. Perhaps the hon. Gentleman will save his remarks about optical problems and optical tests until we reach that specific amendment.

Several Hon. Members: rose—

Mr. Deputy Speaker: Order. Mr. Loyden.

Mr. Loyden: I remind you, Mr. Deputy Speaker, that every test has been mentioned tonight but no objections have been raised from either the Chair or anywhere else. It is important to illustrate the benefits of testing because that is what we are really talking about. Charges are a deterrent to testing and one of the great elements in

preventive medicine is under threat. That, together with the threat to the Health Service, is the most important issue facing us tonight.
All hon. Members, whether speaking in favour of or against the Government's proposals, have pointed out that the Health Service has been moving far too slowly towards preventive medicine although it is moving in that direction. The screenings that take place are a sign of a healthier nation. Therefore, one of the greatest threats to the Health Service is the further erosion of testing that charges will cause. That applies not only to eyesight testing but to dental testing. There is an abundance of evidence to prove conclusively that oral testing can disclose illnesses that could result in either chronic illness or death that would otherwise not be detected.
It is a scandal that we should be debating such proposals in the House 40 years after the Health Service was created by a Labour Government. It is a scandal that we are debating further inroads into and erosions of a service that was once the envy of the world.
All those people who have the interests of the Health Service at heart, who want to see it move towards preventive rather than curative medicine and who want to move away from a drug-oriented Health Service that props up the companies that make billions of pounds of profits from supplying the drugs, believe that tonight's attacks on the Health Service eat into the Health Service and mean that we now have a Health Service inferior to that which we had in the past.

Mr. Key: The amendment is not just about specific health charges; it is not just about money or about the preservation of a particular legitimate vested interest; it is about something much wider and much more fundamental. It is about the best way of improving and maintaining the dental health of the nation.
Economists would tell us that we are into the hoary old chestnut of externalities—in other words, if I as an individual start using lead-free petrol, it does not make much difference to the state of the environment, but if everyone could be persuaded to use it, it would make a great deal of difference. That sort of argument can be applied to the problem facing us tonight.
The argument is about how we can persuade people to react to certain circumstances. Whichever way each of us votes tonight on this issue, I believe that we all want improved dental care for the whole nation. The question is, how do we achieve that? Do we best achieve it by mass state provision which is free at the point of consumption or by unbridled market forces? I shall seek to demonstrate that neither is the complete answer.
The little evidence that there is, as opposed to opinion or judgment—it is striking that, however strongly one feels on either side of the argument, there are only opinions and judgments and one cannot say that the argument is either black or white—shows clearly that the present system of free check-ups has been a failure. About 50 per cent. of people fail to take up the current free service. We are told that there are a number of reasons for that: for example, people may think that they do not need to go to a dentist until they are in trouble; some people have a blind fear of the dentist and some people have difficulty in finding a dentist who is conveniently close to their work. However, the cost of the treatment was ranked bottom among people's reasons for not going to the dentist.
The answer to all those failures must be better education. What have the Government done about that? Well, in 1981 the Government introduced a policy document entitled "Care in Action" in which they recognised the role of education and stated:
Too many endanger their health through ignorance or social pressures. Public action can give people the information they need to make sensible decisions about personal health, and encourage in the community a reasonable attitude towards the main area for prevention".
When the Health Education Authority was set up, the then Secretary of State, my right hon. Friend the Member for Sutton Coldfield (Mr. Fowler), stated:
As a special health authority, the new authority will be an integral part of the National Health Service in England. As a result, it should be more responsive than an outside body can be to the needs of the Service, and in turn will have more influence in setting priorities for the Service and ensuring that the needs of health education and promotion are properly recognised.
That was a most important statement of intent. It is evident that, whatever the deterrent effects of charges, there is only unexpected evidence, as opposed to opinion. In 1976, the Labour Government raised dental charges by 36 per cent. and the number of procedures carried out by dentists rose. Even the evidence presented to hon. Members by the British Dental Association appeared to contradict that case.
The hon. Member for Livingston (Mr. Cook) had some fun at my expense about this, but it is important to consider the document that we have all been sent by the BDA. I have read it carefully and looked at the tables of statistics. It is a profoundly unconvincing case. If ever there were a case of lies, damn lies and statistics, it must be in this document. It is the most selective use of statistics that I can imagine. That is fair enough because the BDA is a legitimate vested interest. I do not therefore decry the case that it seeks to make, but nothing in life is free and the goods and service which are free at the point of consumption are, in general, valued least in society, whether junk mail or tap water. If dental care is free at the point of consumption, people seem prepared to put up with broken appointments, long waits in dingy waiting rooms, out-of-date magazines and rude receptionists. In short, we are very British and do not complain about the poor service.
On the other hand, if we are allocating our own cash, we expect service and standards. That is also in the national interest. We all benefit from the better use of resources. The evidence that we want better standards is there and we are already paying for better standards. Let us consider first the increase in the number of dental hygienists in most of our dental practices. Of course, there are the usual exemptions, but we pay for the benefit of those paradentists, who are a very good thing.
Secondly, may I draw the attention of the House to the problem of AIDS and dentists. That problem will grow significantly. My dental practice—I checked up this morning—is spending well over £1,000 on disposable gloves as a direct result of the AIDS problem, £500 a year on disposable bibs instead of the usual rubber bibs and £500 a year extra on surface anaesthetics instead of needles. At present, dentists have to wait over a year for reimbursement from the state because the state is bad at allocating resources. Standards in practices would rise if dentists had an acceptable cash flow. That would be one of the effects of introducing those charges. I would happily

pay up if I could see the standard of service go up. Both professional services and the quality of environment of dental surgeries would improve.
For five years, as a Member of this House, and for many years before that, I argued to the electorate that the purpose of cutting taxes and reducing Government involvement is not to give us an easy life, but to encourage us to take a more responsible attitude. That is a high moral argument and the care of ourselves, our families and our children should be a first charge on our income. If I can allocate those resources, rather than the inefficient state, it is not only in my interests, but in everyone else's interests too.
I cannot support the Lords amendment. I shall vote against it tonight. I have no intention of ratting on my Conservative principles which I have put to the electorate in election after election. I do not have a monopoly of virtue, nor do I believe that anybody else has in this important debate. However, we are harangued and preached at because of the success of the economy. We are told about record levels of personal debt, conspicuous consumption, imported electronic goods and about calls for deregulation of Sunday trading, the £8 a week per household spent on alchohol, the £4 per week per household spent on tobacco, booming sales of sweets and confectionery for children, but what price optical and dental health?

Mr. Jeff Rooker: I did not intend to speak in this debate and I do not intend to detain the House long because other hon. Members wish to speak. However, I want to illustrate the difference in the speeches of the hon. Members for Lewisham, West (Mr. Maples), for Davyhulme (Mr. Churchill) and for Birmingham, Northfield (Mr. King). The hon. Member for Davyhulme put the case against the Government, but his two hon. Friends spoke in favour of the Government. They and other hon. Members who support the Government are duty bound to put the case for supporting the Government on dental tests and eye tests, and for charging for other tests. They cannot simply say, "We think this is a good idea. People ought to pay for these tests. They should not be free" and then remain silent about all the other tests, for example, cervical smear tests and breast cancer screening. They cannot remain silent about those matters and put the case for the Government.
It is all very well for the hon. Member for Northfield to say, "We freed up the market with regard to dental and eye tests, but we haven't freed up other tests yet." The implication is that, when they have freed up the means of checking for breast and cervical cancer, they will charge for those tests, although the hon. Gentleman could not quite bring himself to say that.
Every Conservative Member of Parliament who is prepared to support charging for preventive tests, leaving aside the charges for treatment and all the other red herrings that have been mentioned tonight, must follow the logic of their argument. We know what is happening. The House and the country are being softened up. When those charges have been introduced, it will be that much easier for other Ministers to say, "It's unfair for all those other tests to be taking place. Now people have to pay for dental tests and eye tests."

Mr. Key: The hon. Gentleman is a fair-minded debater. I could argue the case that we would not have been allowed


by the Chair to digress into the matters that he is raising. However, we should all be prepared to argue about the future funding of the National Health Service. One of the failures of the House and of this nation is that we have not been prepared to debate such difficult issues as the crisis facing the Health Service has become steadily worse.

Mr. Rooker: I am prepared to say, without stepping out of order, that I am not in favour of charging for preventive medicine. It does not matter whether it is eye tests, dental check-ups or any of the other tests associated with preventive medicine. If we go back a few years, I do not think that any hon. Member would have contemplated charging when the mass radiography units were going round the country. That is not so frequent today because there are other safer ways of checking on the problems of lung cancer.
Many millions of people are receiving preventive medicine free at the point of use, but against their will. That is because their water has fluoride in it. I have always supported fluoridation. I am prepared to accept that form of mass preventive medicine on its merits but not in principle. There are many, however, who do not want that mass medication, preventive though it might be.
The free marketeers on the Government Benches would argue that the public should pay for that treatment because it will prevent problems from occurring later. That is the logic of certain Conservative Members. I accept the honesty of the hon. Member for Salisbury (Mr. Key), because it is clear that he would support charges for cervical smears and other tests.
These issues must be faced fair and square. Most of the major diseases that caused generations to suffer were almost eliminated before the medical profession discovered what they were and what the treatment should be. I remember attending a lecture at the community medicine department of Guy's hospital many years ago. Slides were projected that showed graphs illustrating the numbers of people who were not dying as a result of contracting various diseases. We were then told when a cure had been found. It was clear that the fall in the line on the graphs did not depend on treatment. Instead, there was a direct relationship to public health policy that embraced community medicine and good hygiene. That is a factor that must be taken on board.
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With advances in science it may be that other tests will be invented for some of the diseases that are prevalent now and for others that we may not even know about. A test for AIDS is an example that I use in passing, for five years ago we might not have known anything about the disease. There will be tests invented to prevent people of whatever age falling foul of certain illnesses or diseases, and we know that those tests will save money.
There are those who contract certain illnesses or diseases because we have not developed tests that will tell us when they are in the early stages of contracting them. If the relevant tests were invented, they would definitely save money. They would be cost effective. Is it being argued that although new tests will save money we should introduce charges for them? Surely that would be contrary to public health policy and our attitude to it for the past 100 years or more.
The Under-Secretary of State for Health, the hon. Member for Derbyshire, South (Mrs. Currie), is right to think that people are still ignorant about their own bodies. From time to time the hon. Lady tells the country the truth. Whenever she does so there is a reaction, but that is because of the way in which she puts her message across. The hon. Lady, in her own way, is attempting to educate. She is intent on educating the people en masse so that they can take better care of their bodies. She knows that most people are ignorant about their bodies in detail, especially when it comes to what they do to their bodies and the illness that will ensue 10 or 20 years later. The hon. Lady is engaging in a process of education.
An element of preventive medicine is to enable the public, without any barriers of mystique, to subject themselves to checks. If only small barriers are erected that does not matter. In effect, the money does not matter. Conservative Members talk about 60 per cent. exemptions, but if there were no problem about money we would not have arguments about two out of every three who are eligible for family credit not receiving it. There is ignorance of the system and ignorance of what is available. The same applies to charges for checks and to those who would be frightened of taking advantage of them. Unless Ministers are prepared to argue that they will consider later the cost effectiveness of other checks, their words are not worth the candle. I do not care what the costs are, because costs do not really matter. If the proposed costs are halved, some people will still be prevented from taking advantage of them.
We know that some people, either through illogicality or ignorance, will be prevented from going for checks. That is not good enough. That is contrary to everything that has happened in the development of public health policy over the past century. It would be a bad day for the Government and the House if we were to let that happen.

Mrs. Gillian Shephard: I shall be very brief because most of the arguments that it is possible to deploy on this subject have been thoroughly rehearsed tonight, if not in earlier debates. However, I want to make two points, the first of which relates to the principle of charging for dental check-ups. No one can dispute the fact that the power to make appropriate charges for health services was built into the National Health Service Act 1946 from the very beginning. No one has tried to dispute the fact that Governments of all political persuasions have taken the chance to make charges when they wished during the 40-year history of the NHS.
My experience may be unique, but I have rarely had a free dental check-up. My dental check-ups always seem to be accompanied by an X-ray, cleaning or scaling for which I have to pay. I agree with my hon. Friend the Member for Ealing, Acton (Sir G. Young) who said that the boundaries between treatment and examination in that area of the Health Service are very blurred. Most people who attend a dental surgery expect to be charged either for something following from the check-up such as an X-ray or cleaning or for a course of prescribed treatment. I have no difficulty with the principle of charging for dental check-ups.
Not much has been made of my second point. Check-up charges are part of a total package for primary health care contained in the Bill. The package is designed to produce improvements worth £600 millon over the next three years for the primary health care network. As


represent a rural constituency in which primary health care is of the utmost importance, I welcome the improvements and I shall have no difficulty in supporting the Government in support of the charges as part of that package of overall improvements.

Mr. Carttiss: As has already been said, all the arguments have been advanced. When my right hon. Friend the Leader of the House was asked whether the Government would change their mind after the amendments were passed by the Lords, he said in April or June that he had heard no new arguments that would change the Government's view.
I have heard no new arguments to cause me to change my view that the Government have made a mistake. I recognise that my right hon. and hon. Friends on the Government Front Bench and my colleagues on the Back Benches have put forward some very persuasive arguments, and I understand what they have said. That is a matter of judgment. I would be very surprised if someone was deterred from having a dental check-up if the charge was £3. We are not talking about eye tests or a higher charge of £10 which would be a different deterrent.
Conservative Members have concentrated their attention on wealthy people whom it is alleged do not need free check-ups. No matter how wide ranging are the Government's exemptions, there will still be people, as we all know, who are just above that level and for whom a charge will make a difference. Of that there can be no doubt. If it does not make any difference, why do the Government continue to subsidise the wealthy middle class who want to attend opera and the Royal Shakespeare Company performances? My hon. Friend the Member for Hayes and Harlington (Mr. Dicks) is always on about that. Let us get the facts right.
Why is it such a dreadful thing to say to people who can afford to go somewhere else that they cannot have that one test free in the interests of preserving the principle of having an initial free check?
We have heard a lot about prescription charges. Every time anyone mentions the charges for the two tests we are told that we do not oppose charges for prescriptions. If I had been a Member when the Labour Government introduced prescription charges, I might have done so. What I do know is that once the principle—it may well have been right—was conceded, they were appropriate, indeed unavoidable, given the vast range of services that my hon. Friend the Member for Birmingham, Northfield (Mr. King) identified as showing that we have a much more comprehensive Health Service now than when it was formed. The arguments for that might be clear, but the fact remains that prescription charges keep going up and there is no doubt that these charges will go up. There is no way that in three years' time we will be talking about £10 for eye tests or £3 for dental check-ups.
I oppose the principle of charging for doctors' visits and all the rest, which has been debated thoroughly. Hon. Members have been nodding their heads. My hon. Friend the Member for Salisbury (Mr. Key) went like this when the hon. Member for Birmingham, Perry Barr (Mr. Rooker) asked whether he would approve of charging for cervical smears. Many Conservative Members will put their hands up if they are told to do so by my right hon. and learned Friend the Chief Whip, who has just walked in.

Mr. Deputy Speaker: Order. I hope that hon. Members will remember that Hansard cannot interpret hand signs.

Mr. Carttiss: The case is being advanced that there is no deterrent in these charges. Indeed, we have heard some interesting and persuasive points of view. It has been said that if we charge for something everybody will want to have it. That may well be true; I do not know. But this is a fundamental principle.
I am not sure whether the Government know the costs involved in introducing these charges. They say little. For example, we are told that charges are no deterrent. We are told that after a time patients will come back.
In Great Yarmouth dentists who are capable of operating on impacted wisdom teeth are referring their patients to the local hospital to have the operation there, not on medical or clinical grounds, but on social grounds because their patients are just above the exemption limit; they would have to pay the dentist but can be treated free in hospital.
There are many more such cases. If one talks to people who visit hospitals regularly, as I do, they tell of people being redirected. That is what will happen. People will go to their general practitioner complaining of a headache. Once he would have sent them to the optician, but now he will send them to the eye clinic in the local hospital. Make no mistake about it. Of course, that will not apply to everybody.
I seriously question how much of the £50 million that it is alleged will be redirected will be saved when the time comes. I congratulate my right hon. and learned Friend the Secretary of State and his colleagues in the Department of Health, and, indeed, my right hon. Friend the Chief Secretary to the Treasury, on having agreed the significant increase of £1·25 billion for the Health Service. I was asked to listen to the Autumn Statement. Having done so, I am reinforced in my view that we should not be introducing these charges.
When my right hon. and learned Friend opened the debate he observed that the Autumn Statement had certain elements in it and he asked whether we all understood it. I have examined it, and I find that when my right hon. Friend the Chancellor of the Exchequer stands at the Dispatch Box next March to present his Budget he will have a surplus of about £10 billion to £15 billion that he can use in various directions, including reduced taxation. He could also use it to continue providing what I happen to believe—although I recognise the alternative arguments—is a fundamental principle, a free service of dental and eye inspection.
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Opposition Members made the point that one can go to a GP and say, "I have something wrong with my foot, doctor," and that he will examine it without charging £3. One might say to him, "I have something wrong with my arm—have a look at it." He might reply, "There is nothing wrong with it. It is all in your head." Why should those services be free while others are subject to a charge? Right hon. and hon. Members have asked that question several times today. It was asked in the debate on Report, but still no answer has been given. We shall not be given an answer because many of my right hon. and hon. Friends consider, for sound reasons, that there ought to be more Health


Service charges. I respect their view, but I still oppose it, and tell them that I hope very much that this is the last we shall hear of their proposal.
Conscious as I am of the passage of time, I shall conclude by quoting Bruce Anderson writing in The Sunday Telegraph:
There is no justification for Tory Members whining and griping every time they have to explain an unpopular decision in their constituencies.
That is not what it is all about. I had to explain to my constituents why it was that on Monday, and again on Thursday, I voted to pour more money down the EC drain on their behalf—much more money than is in question here. I also had to explain with enthusiasm to my constituents why the British Government allowed the American Air Force to use air bases in East Anglia from which to launch their bombing attack on Libya. I had to explain that to 70 constituents who were in Libya, working for the oil industry there. Worse still, I had to explain it to their wives, who were worried about them—but I had no difficulty doing so.
Great Yarmouth is not just my constituency. It is my home. It is my parents' home and the home of my grandparents and of their parents. I have to face my constituents not to explain unpopular decisions but to explain in terms that I can support and believe why I vote in the way that I do in Divisions. I can explain to my constituents why the Government are introducing this measure. I can understand the argument that has been advanced that the £50 million involved can be more effectively directed elsewhere.
My right hon. and learned Friend the Secretary of State commented on radio last night on whether those of his colleagues who oppose the Government wish to have on their consciences the loss of £50 million that could be spent in other areas. I do not want to have on my conscience the two people of whom my hon. Friend the Member for Lewisham, West (Mr. Maples) does not think too much because their dentist had discovered only two oral cancers. It is a case not of whingeing and whining but of being extremely proud of a Government who have done more for the Health Service than any other.
I strongly object to having to march into the Lobby with Opposition Members because on this occasion they happen to be right and the Government wrong. I trust that even at this late stage the Government will join me. I am not against the Government; I am voting for the Lords amendment and for the people who sent me here, and I hope that the Government will do so as well.

Mr. Peter Griffiths: The response by my right hon. and learned Friend the Secretary of State to my modest intervention during his opening speech was profoundly disappointing and disturbing. It was disappointing because it compounded what I thought at first was a modest error: when he listed the possible uses for the sum that could be saved by charging for dental checks, he did not mention any that had any relation to dentistry, and I now ask him to remedy that.
I found my right hon. and learned Friend's response offhand in the extreme. It was clearly intended to suggest that he agreed with my hon. Friend the Member for Birmingham, Northfield (Mr. King), who said earlier this evening that the optical and dental services were on the

fringe of the NHS. That is certainly not true of dental charges. For many people the regular visit to the dentist is their most common meeting with the NHS. I visit my dentist every six months; I do not visit my doctor that often. Throughout human history until the last century, inadequate dental health was one of the greatest causes of physical misery, and I consider the dental service one of the most important parts of the Health Service. My right hon. and learned Friend missed a great opportunity in brushing aside the suggestion that funds raised by imposing charges on dental inspections should be used at least in part to improve dental services.
I am particularly concerned about this because it contradicts comments made during the Bill's Committee stage by my right hon. Friend the Chancellor of the Duchy of Lancaster when he was Minister for Health. He said then that more than £50 million would be spent on improved primary health care, and that, while not all of it would be spent on dental services, they would be a priority. The impression given today was that they would not.
My hon. Friend the Member for Northampton, South (Mr. Morris) said that he could accept the imposition of charges for dental inspections if he then saw a new orthodontic hospital in Northampton. If we could see real developments in certain areas of dental provision, we might be able to argue that that was an improvement. Surely few people would argue that, if we were starting from scratch and had £50 million to spend on the dental part of the NHS, we should use it to provide free dental inspections for those who can afford to pay. But what worries me is that we have no indication that the Government intend to use the funds that they are raising —or at least a major part of them—to improve dental care.
My right hon. and learned Friend said that he felt that during the past few weeks the number of people expressing opposition to the measure had increased. I well understand why people may have begun to wonder when they find that the Government have apparently shifted their ground since the Committee stage. I am seeking a direct and specific assurance from the Minister that primary dental care will benefit from the change in the direction of funds brought about by the introduction of charges. I consider that that is the crux of the matter. That is what I wish to hear.

Mr. Keith Mans: Hon. Members have spoken about the many well-worn arguments that we have had tonight. Those arguments did not start tonight; they go back to last December when the Standing Committee of which I was a member first started discussing these clauses. Since last December, the Government have made available £3 billion of extra public money to the National Health Service. Therefore, I find it just a little extraordinary that Opposition Members should be so concerned about these matters, yet fail abysmally to applaud the huge extra sums of money that have been made available during the past year.
I find it extremely difficult to understand how they can suggest that many problems will arise from the charges. I do not consider that there is any fundamental difference between charging for treatment and charging for the tests that we are discussing tonight. In that respect I agree with my hon. Friend the Member for Ealing, Acton (Sir G. Young).
Opposition Members have produced statistics that suggest that a £3·15 charge for a check up will deter people


from going to the dentist. I do not believe that will be the case. It is not proven, and, judging from the arguments used tonight, it is most unlikely to occur.
It is much more likely that as a result of our debate tonight we shall well end up with a better dental service. It will not be the case that, simply because people have to pay £3·15 for a dental check-up, if they can afford it, that will affect whether they go to the dentist. However, the charge may affect the dental service that is provided. I am absolutely convinced that, although quite clearly not all the extra money will be spent on dental check-ups, some of it at least will help that cause. I strongly believe that we need to monitor exactly what occurs if the charges are introduced. We need to find out whether there is a decrease in the take-up rate of dental check-ups. I believe that the charges will make very little difference.
There is a more fundamental reason for rejecting the amendment. Ever since the foundation of the NHS, it has been short of funds for one reason or another—latterly much less so. The expanding need for health care in this country means that we have to make an increasing individual contribution to the Health Service. One of the main purposes of the charges is that they will allow people who can afford it to contribute to their own health. That must be a step in the right direction and must result in more resources being released for more important and more fundamental health care. Therefore, I shall support the Government tonight and I ask my hon. Friends to reject the amendment.

Mr. Edward Leigh: I hesitate to take part in the debate because the only time that one of my speeches in the House was reported around the world was when, in mid-flow, the crown expertly fitted to my front tooth by the National Health Service fell on to the Bench beside me. I hope that I shall be more successful this evening. [HON. MEMBERS: "Keep your mouth shut then."] I owe it to my constituents to say a few words. I do not doubt the Opposition's sincerity, but they have not examined needs and priorities accurately—the same needs and priorities that every Government have had to tackle. Perhaps I may quote the Chancellor of the Exchequer who said:
It is clear that it is not possible in existing circumstances to permit any overall increase in the expenditure on the Health Services. Any expansion in one part of the service must in future be met by economies or, if necessary, by contraction in others. In exercising this essential control over total expenditure, regard will of course be had to priorities."—[Official Report, 18 April 1950; Vol. 474, c. 59.]
That was what a Labour Chancellor, Sir Stafford Cripps, said. He was trying to grapple with the difficult problem of balancing needs and resources. A Minister of Health said:
I am afraid it is necessary this afternoon—we need more money than my right hon. Friend the Chancellor of the Exchequer could see his way to provide. The measure we have taken to get that money has been described in some quarters as an attack on the Health Service or as the first step in dismantling the Service. I am tempted to voice the indignation I felt when I read those words, but I will refrain. Instead, I hope that my hon. Friends will reflect on what I have said this afternoon about the intentions and plans of myself and of my right hon. Friend to expand and develop the hospital and general practitioner service".—[Official Report, 24 April 1951; Vol. 486, c. 235.]
That was said by Mr. Marquand, a Labour Minister of Health, when imposing charges on 24 April 1951. Already in the history of the National Health Service, Governments have had to make choices. We recognise that

if we are to protect people who can least afford to pay, we must ask those who can afford to pay a modest amount to make some contribution.

Mr. Brian Wilson: Will the hon. Gentleman give way?

Mr. Leigh: No. I am trying to draw to a close.
The only alternative to asking people who can afford to pay to make a modest contribution is the philosophy of the queue. We all remember the words of the grandfather of my hon. Friend the Member for Davyhulme (Mr. Churchill), who reminded us that the Socialist way is he way of the queue. Ours is the way of the ladder. When people fall out of the queue, Socialists will employ officials to put them back in the queue. We give people a ladder, and if people fall off the ladder we provide the best ambulance service in the world.
Even Socialist Governments have recognised that the queue eventually becomes intolerable. I have another interesting quotation which runs:
the ideal of a free service lasted in fact barely three years from its inception—charges of some kind have been in operation ever since 1951 … I have made my view known widely, over a long period, that ideally the National Health Service should be free to everyone at the time of need, and it is not at all difficult to find telling quotations from past speeches of mine over the years."—[Official Report, 30 May 1968; Vol. 765, c. 2255.]
That was said by Mr. Kenneth Robinson when imposing prescription charges on behalf of the Labour Government in 1968.
Even Labour Governments have had to impose charges to avoid the philosophy of the queue. I do not doubt the sincerity of Opposition Members but, like most sincere people, their sincerity is small part self-deception and large part humbug and hypocrisy. One has only to examine the record of Labour Governments to realise that.
The argument that charges should not be imposed is false. Successive Governments have realised that they must be imposed. We must therefore ask whether it is necessary to impose these charges.
We know that some 20 million people—those who are least able to pay—will be exempted from the charges. We have dealt with the deterrent argument and heard that between 1976 and 1986 the number of people who received dental treatment increased by 7 million. We have heard also that people on the borderline of income support might be deterred from taking dental treatment. If that argument is true, is it not an argument against more charges? [HON. MEMBERS: "Yes."] There is the voice of the part of the Labour party which opposes all charges. If those hon. Members are honest, and lay aside self-deception, hypocrisy and humbug, they will realise that a Labour Government would have to impose such charges. I shall vote against Lords amendment No. 20.
My final point might give some comfort to Opposition Members. The points made by the hon. Member for Birmingham, Perry Barr (Mr. Rooker) were worth while. The time may come when the Government have to grasp the nettle of charges on other services. I do not say that such charges are desirable or necessary. My right hon. and learned Friend the Secretary of State gave the sincere and honest answer that in his view they were not yet necessary. The time may come when, if the NHS is not to absorb an increasing proportion of GNP and we are to continue to


provide services to those in need, we have to consider charges on other services. I do not for a moment think that that necessarily proves that these charges are wrong. They are a necessary fact of life which we must accept. I am sure that, for that reason, Ministers will get a majority for their motion.

Mr. David Atkinson: The House will welcome the extra £1·6 billion which my right hon. Friend the Chancellor has announced today for the National Health Service in England and Wales. I congratulate my right hon. and learned Friend the Secretary of State for Health on his considerable personal achievement in this respect, but we cannot continue indefinitely to find these extra massive resources for the NHS without a clear policy and direction for the future of health services. I hope that that will be the outcome of the review which my right hon. and learned Friend has inherited. It is therefore all the more regrettable that, on the same day that the Government have demonstrated, once again, that they are generating new resources for the NHS and much else, they find that they must also proceed to reinstate charges for dental treatments. As my right hon. and learned Friend the Secretary of State has reminded us, the Health and Medicines Bill is based on the 1986 Green Paper, "Primary Health Care", which contained a range of measures to promote good health and preventive care. Those measures will cost money to implement in the short term in order to save money in the long term through better health.
Two years ago, I consulted widely in my constituency with all the doctors, dentists and chemists about those proposals. The general reaction was positive—they welcomed them. Before us today is a new charge for dental examinations which was not proposed in the Green Paper, and therefore was not the subject of that consultation. It is obvious that, if it had been, the message would be what we are receiving now from the professions, that such a charge will serve to negate some aims that the Bill is designed to achieve and will be self-defeating, both financially and for the health of the patient.
I oppose the introduction of a dental examination charge for three reasons. First, it abandons the principle that the National Health Service should not charge patients for advice. Although I believe that we should be doing much more to encourage people to cover privately for their health needs, out of choice, the fundamental principle of a state-run service must be to enable people to seek medical advice regardless of means and without charge.
Secondly, once that principle has been broken, it becomes easier to introduce the charge elsewhere—for advice from the doctor, for screening and for smears. We have heard of a number of services where such a charge could be introduced. Once the principle has been broken, it also becomes easier to increase the charge. If the Bill is passed, this year we shall introduce a charge of £3·50 for a dental check. Next year, it will undoubtedly be at least £5, and it could escalate a the same rate as charges for dental treatment in recent years. That is not the right way to reform the financing of the NHS.
Thirdly, and contrary to what my right hon. and learned Friend the Secretary of State said earlier today, I accept that there is much in what the dental profession is

telling us, and has told my right hon. and learned Friend —that a dental examination charge, modest though that proposed is, will prove to be a disincentive to young adults, especially the 18 to 20-year-olds who will have to pay it. I accept that they are not as responsible as they should be and they will avoid going for a regular inspection. In the long run, that will prove more costly both to the National Health Service and to the patient. Treatment almost always follows the free examinations— treatment for which the patient pays. Examination charges for 18 to 20-year-olds will raise just £10 million and I do not believe that it is worth the candle.
I had expected my right hon. and learned Friend, by way of a concession, at least to exempt the elderly from the charges, but apart from those already specifically exempt he has not done so. In view of the early detection of oral cancers through routine dental examination, I believe that that is particularly harsh.
Had my right hon. and learned Friend the Minister said that the charges were a temporary measure to finance the preventive health care programme that he is about to launch—with, I hope, the wholesale introduction of fluoride in the drinking water—and that the charge would be lifted as soon as evidence showed that the programme was working and demand for treatment falling, I would have reconsidered my position. But my right hon. and learned Friend has not suggested that. The charge will be a permanent addition to the financing of the National Health Service and in my view will sabotage what this otherwise admirable Bill is designed to achieve. The abandonment of the principle of free examination under the National Health Service is not something that I can support today.

Mr. Mellor: The essential background to this wide-ranging and well-informed debate is that in the past 10 years provision for our dental services has been greatly increased, leading to better dental health among the population as a whole. There has been a marked increase in take-up of dental treatment throughout the country against a background of markedly increased charges for the treatment provided. That is the essential factual background against which all who are still considering how to cast their vote should begin their consideration.
Provision has been dramatically increased in the past 10 years. In 1978–79 the cost of dental services was £279 million. In 1987–88 it was £820 million—an increase of 43 per cent. in real terms. Even allowing for the impact of the contribution paid by the public in charges, that still represents an increase direct from the Government of 26 per cent. in real terms. That has led to better dental health. In 1973, 29 per cent. of five-year-olds in England and Wales were free of dental decay. By 1983 the figure had risen by more than half to 52 per cent. In 1968, the percentage of adults with no natural teeth was 37 per cent. In 1985 it was 22 per cent.
The percentage of adults attending the dentist regularly has risen from 40 per cent. in 1968 to 50 per cent. in 1985. As my hon. Friend the Member for Ryedale (Mr. Greenway) reminded us, however, even though 50 per cent. attendance is better than the 40 per cent. of 20 years ago, it still means that 50 per cent. do not go to the dentist regularly. That is an issue to which we should be devoting a great deal of attention.
There has also been increased take-up of the services that dentists have to offer. In 1979, the number of courses


of treatment in the United Kingdom was around 31 million. By 1986–87, only seven years later, there were 37 million courses of treatment. My right hon. and learned Friend has already reminded the House that especially noteworthy among that increase in treatment was the number of pensioners having their teeth checked—in most cases in the clear knowledge that it would lead to a course of treatment for which 80 per cent. of them would have to pay. Indeed, the increase in the number of pensioners having dental treatment during that period was 92 per cent.

Mr. Hayes: I am not in any way challenging my hon. and learned Friend, but something that he said a moment ago might have inadvertently misled one or two of my hon. Friends. Is it true that pensioners will not receive any exemption unless they are on income support?

Mr. Mellor: Yes, that is right. We estimate that of the 6·9 million people who will be exempted by virtue of receipt of income support, 2·5 million will be pensioners.
It is interesting that the take-up of treatment has risen sharply, notwithstanding the background of increased charges for treatment that have been significant during the past 10 years. It is also interesting to hear the Opposition's ritual denunciation of charges. However, we know that back in 1976 they put up charges for dental treatment by 35 per cent. and again in 1977 by 27 per cent.
In case the House is troubled by the Opposition's attitude, I must point out that they did not fuss about the odd three quid back in 1977 when they put up charges for plastic dentures from £12 to £20 and for metal dentures from £12 to £30. The minimum charge for treatment rose from £12 to £30 at a stroke, an increase of 150 per cent. We do not really need too many denunciations from the Opposition.
It is fair to say that in the increasingly prosperous society that has been created in Britain during the 1980s, the Government have also put up dental charges so that from a total of 20 per cent. of the cost of the dental service coming from patient contributions in 1980 the figure has risen steadily over the years to a current total of 32 per cent. That increase in patient contributions from 20 per cent. to 32 per cent. of the cost of an expanding service has happened while that service continued to expand and to treat increasing numbers of people—including an increasing number in the most vulnerable group, according to the definition applied by some of my hon. Friends. That is something that should be taken into account.
It is true that certain types of treatment have reduced in number, such as extractions and fillings, because they are not so necessary today. It is not because people are not taking up treatment, but because the general dental health of the population is improving. It is interesting to note that increased take-up has been more marked in some of the more expensive procedures for example, crowns in-creased by 83 per cent. and bridges by 535 per cent. during the lifetime of the Government, yet those are among the most expensive treatments available up to the £150 maximum that we have already specified.
The provision that we are debating is a charge of £3·15 for a dental examination—75 per cent. of the actual payment made to the dentist. It fits in with the procedures introduced in April under which, instead of there being up

to 100 per cent. charges—a point made by my hon. Friend the Member for Ryedale—we fixed on 75 per cent. for all procedures up to a maximum of £150. That is not without significance because it means that even with these additional charges if the House is minded to permit us to render them—more than 6 million of those who received 32 million courses of treatments last year would pay less than they did in April because of the adjustments. Thai is further evidence to convince anyone who needs persuading of the limited cost of the exercise to the patient.

Mr. Churchill: Can my hon. and learned Friend say whether the constituent whom I mentioned, who is single, self-employed and in his late 50s, without dependent children and in full-time employment, but earning only one quarter of average earnings, would qualify for free tests despite the fact that he is not on income support'?

Mr. Mellor: If my hon. Friend's constituent is not on income support, I am afraid that he will not qualify unless he falls within the category of the nearly poor set out by my predecessor in the debate in April. With the greatest respect, hon. Members cannot expect Ministers to be able categorically to answer such questions at the Dispatch Box, although it is something that would be well worth checking.
One of the key questions that has arisen in the debate concerns what we are really trying to achieve in the dental service. It is quite clear what we are trying to achieve. We are trying to build on our unparalleled success—certainly since the 1970s—to ensure that when people visit dentists, they visit well-trained dentists capable of dealing with all their problems. Above all, we want more people to visit the dentist. We know that 50 per cent. do not. The hon. Member for Livingston (Mr. Cook) drew entirely the wrong conclusions from the figures that he gave for teenagers who were not turning up for dental checks. It is interesting to note that people do not turn up for dental checks even though they are free. It shows that the problem is altogether more difficult than the question whether people will be deterred by the £3 charge. People put plenty of other reasons for not going to the dentist before cost. There are all the old fears about pain, and doubts about whether the dentist will be any good. One crunches one's way through all the unsuitable foods denounced so regularly by my hon. Friend the Parliamentary Under-Secretary of State and one thinks that one's teeth are standing up to the strain all right and says to oneself, "Why bother to go to the dentist?"

Mr. John Battle: rose—

Mr. Mellor: Not for the moment.
That is why the focus of our attention is increasingly on prevention—on reaching out to people to find ways of persuading them to take better care of their teeth. That is why in this year alone we are spending £250,000 on an advertising campaign especially targeted on teenagers to try to persuade them to go for treatment.
Let me take up the point raised by my hon. Friend the Member for Portsmouth, North (Mr. Griffiths) and by my hon. Friend the Member for Ealing, Acton (Sir G. Young) about prevention campaigns. I wish I could have the attention of my hon. Friend the Member for Portsmouth, North, although I realise that it is difficult to hear against the background of the Opposition—[HoN. MEMBERS: "Get on with it".] All the money—the £50 million that will no


longer need to be paid out on dental examinations—will go back into the Health Service. I am not saying that every penny will go back into the dental service but there will be significantly expanded provision in dental services. My hon. Friend knows, from the figures that I have cited—an increase from under £300 million to over £800 million in eight years—I say that against the background of real achievement in the past— [Interruption.] One wonders where the Opposition get their facts when they ask about the expanded commitment. There are 22 per cent. more dentists in England and Wales than when the Labour Government left office 10 years ago. That is what we mean by expanded provision and a few jeers and caterwauls will not change that.
What do we seek to do to vindicate the commitment? We are looking to expand health education initiatives, to investigate means of improving the marketing of dental care and to increase the number of people who seek regular dental care. We shall be giving increased financial assistance towards the cost of establishing and equipping dental practices in those areas short of dentists. That should be of interest to Opposition Members who represent inner-city constituencies and who regularly say that they do not enjoy the level of provision available elsewhere in the country.

Mr. Battle: rose—

Mr. Mellor: I shall just finish a point, and then I shall give way to the hon. Gentleman. We shall give more money to expand the number of places in the vocational training schemes designed to improve the skills of family dentists, and more money for postgraduate training courses and for a training allowance for attendance at approved courses, because these days not every dentist has to come from Australia.

Mr. Battle: Will the hon. and learned Gentleman explain to the House why not one of the professional bodies that deal with this matter agrees with the Government on this issue?

Mr. Mellor: It is called vested interest, and I thought that Opposition Members— [Interruption.]
Another point was very properly raised during the debate, which was the question of additional charges. I know that a number of hon. Members are concerned about this matter, and I say categorically that the Government have no plans to introduce further charges —[Laughter.] I should like to reiterate and quote from the words of my right hon. Friend the Prime Minister, when she was interviewed on the BBC nine o'clock news on 21 December 1987. She said:
We have in fact introduced one or two extra charges which we think people can well afford, but at the moment we are not talking about extra charges beyond those which we have introduced, and the Government have no plans to introduce further charges.
My hon. Friend the Member for Davyhulme (Mr. Churchill) and one or two other hon. Members asked what the difference was between charging for dental inspections and charging for people to have their breasts checked for cancer or to have a cervical check. Of course, I have said that there are no plans—nor would there be—to charge for such examinations. There is a difference in kind between those checks, which are a systematic search for disease,

and dental checks, which are basically a check to see whether dental treatment is required. [HON. MEMBERS: "Rubbish."] Oh yes, it has the fortuitous additional benefit that if a case of wider mouth disorder becomes apparent, a dentist can spot it. However, I say to hon. Members, who base their case on the detection of oral cancer, that it is idle to pretend that dental checks were ever intended or devised as a means of screening for oral cancer. They were not. That is categorically so.
I shall turn to the question of oral cancer which appears to me to be a significant point. Oral cancers are tragic and serious, and everybody wants to see them detected and, where possible, cured. Happily, it is a relatively rare condition in the United Kingdom, where there are some 1,500 cases of cancer of the mouth each year.

Mr. Hayes: It is 2,609 per year.

Mr. Mellor: My hon. Friend gives a false figure and I shall correct him later. There are 1,500 cases of cancer of the mouth each year. That means, spread as an average across all the dentists in the United Kingdom, that the average dentist would see two or three cases of oral cancer in his entire working life. The off-chance of picking out an oral cancer cannot be the basis for 100 per cent. free dental examinations.—[Horn. MEMBERS: "Withdraw."]

Mr. Hayes: rose—

Mr. Mellor: rose—

Hon. Members: Give way.

Mr. Mellor: In a recent survey the figures show that 40 per cent. of oral cancers are detected by dentists. That means that one dentist will see only one case of oral cancer every 20 years. I give way to my hon. Friend the Member for Harlow (Mr. Hayes).

10 pm

Mr. Hayes: I am grateful to my hon. and learned Friend for giving way. According to all the professional bodies, which until this moment have been accepted by the Department of Health, last year alone, 2,604 oral cancers were discovered, approximately 41 per cent of which were presented to dentists. I am sure that my hon. and learned Friend will accept that one difficulty is that doctors are not properly trained to diagnose diseases of the oral cavity, whereas dentists are.

Mr. Mellor: If I may say so, that is a tendentious assertion.

It being Ten o'clock, the debate stood adjourned.

BUSINESS OF THE HOUSE

Ordered,
That, at this day's sitting, the Lords Amendments to the Health and Medicines Bill may be proceeded with, though opposed, until any hour.—[Mr. Fallon.]

Lords amendments again considered.

Question again proposed.

Mr. Mellor: When the bell intervened, Mr. Speaker, I was saying that my hon. Friend had quoted his article in the Evening Standard which, no doubt, has remunerated him well enough to enable him to pay for his next check-up —[HON. MEMBERS: "Disgraceful."]

Mr. Hayes: rose—

Mr. Speaker: Order.

Mr. Hayes: On a point of order, Mr. Speaker—[Interruption.]

Mr. Speaker: Order. The hon. Gentleman may make his point if the Minister gives way.

Mr. Mellor: I am teasing my hon. Friend—[Interruption.]

Mr. Hayes: rose—

Mr. Speaker: Order.

Mr. Mellor: I purchased a copy of the Evening Standard to read my hon. Friend's article. The figure that my hon. Friend gives of 2,600 oral cancer cases includes cancer of the throat which is not detected by dentists. It is cancer of the mouth cavity that accounts for 1,500 cases—[Interruption.]

Mr. Speaker: Order. I sense that we are coming to the end of this important debate.

Mr. Mellor: Later in his article, my hon. Friend states that "a mere £140 million" is what is at stake tonight. That does not—

Ms. Joan Walley: rose—

Mr. Mellor: No, I cannot give way now.
That does not seem a fair basis on which to decide how to cast one's vote in this debate because £140 million is a large amount of money in Health Service terms—

Mr. Hayes: On a point of order, Mr. Speaker—

Mr. Mellor: My hon. Friend—

Mr. Hayes: rose—

Mr. Speaker: Order. Is it a point of order?

Mr. Hayes: With respect to my hon. and learned Friend, he suggested that I profited from the article— [Interruption.]

Mr. Speaker: Order. That is not a point of order for me.

Hon. Members: Withdraw.

Mr. Mellor: Of course, if it will make my hon. Friend feel any better about it, I will withdraw any such suggestion. I should like to deal with what he actually said—

Mr. Martin Flannery: On a point of order, Mr. Speaker. Why do you not make the Minister withdraw that comment?

Mr. Speaker: Because I am not responsible for what is said, provided that it is in order. It may have been in bad taste, but it was in order.

Mr. Mellor: My hon. Friend wrote:
The cost of retaining the free dental and sight check is a mere £140 million".
No hon. Member should vote tonight under any illusion, because £140 million is a great deal of money in NHS terms. I advise my hon. Friend that the total cost of all the medical services offered by the district health authority which contains his constituency amounted last year to £41·7 million. That buys an awful lot of treatment.
We shall be concerned later tonight with the treatment of eye disease. I attended the opening, by Her Majesty the Queen, of the brand new, rebuilt Moorfields eye hospital

last week. That cost £15 million, only one tenth of the mere £140 million of which my hon. Friend the Member for Harlow spoke. We want to reduce the number of patients on the waiting lists. For £25 million last year, we did over 100,000 more in-patient operations—[Interruption.] —and we shall do more than that next time. I wish that Opposition Members would be quiet for just a few minutes—[Interruption.]—and I shall finish a great deal sooner. It comes down to a judgment whether, in this day and age, when the man on average wages is 30 per cent. better off than he was 10 years ago, we think that £3·15 once or twice a year will be a major disincentive to people to go to the dentist when over 20 million people will be exempted from these charges.
When my right hon. and learned Friend took over the Department, it was open to him to say that he thought that these charges were misconceived. He and I looked at the matter and concluded that what we want to do for the Health Service lies in far more vital areas than preserving an increasingly archaic rule in a world where 60 per cent. of the population is well able to make that payment.
I urge my hon. Friends to bear in mind when they go into the Lobby tonight that the only consequence of the Government failing to carry this measure would be our having to come back with proposals that they would find more unpalatable. It is hardly possible to think of any less damaging way of raising money to make our Health Service even better than to introduce these charges.
This is a great day for the National Health Service, when over £2 billion of extra resources have been won for the service. It will be an even better day for the service if the decision made in the House of Lords is reversed tonight and I therefore urge the House to reverse that decision.

Question put, That this House doth disagree with the Lords in the said amendment:—

The House divided: Ayes 300, Noes 284.

Division No. 462]
[10.07 pm


AYES


Adley, Robert
Bowden, Gerald (Dulwich)


Aitken, Jonathan
Bowis, John


Alexander, Richard
Boyson, Rt Hon Dr Sir Rhodes


Alison, Rt Hon Michael
Brandon-Bravo, Martin


Allason, Rupert
Brazier, Julian


Amery, Rt Hon Julian
Bright, Graham


Amess, David
Brittan, Rt Hon Leon


Amos, Alan
Brooke, Rt Hon Peter


Arbuthnot, James
Brown, Michael (Brigg &amp; Cl't's)


Arnold, Jacques (Gravesham)
Browne, John (Winchester)


Arnold, Tom (Hazel Grove)
Bruce, Ian (Dorset South)


Ashby, David
Budgen, Nicholas


Aspinwall, Jack
Burns, Simon


Atkins, Robert
Burt, Alistair


Baker, Rt Hon K. (Mole Valley)
Butcher, John


Baker, Nicholas (Dorset N)
Butler, Chris


Baldry, Tony
Butterfill, John


Banks, Robert (Harrogate)
Carlisle, John, (Luton N)


Batiste, Spencer
Carlisle, Kenneth (Lincoln)


Bellingham, Henry
Carrington, Matthew


Bendall, Vivian
Cash, William


Bennett, Nicholas (Pembroke)
Chalker, Rt Hon Mrs Lynda


Benyon, W.
Channon, Rt Hon Paul


Biffen, Rt Hon John
Chope, Christopher


Blackburn, Dr John G.
Clark, Hon Alan (Plym'th S'n)


Blaker, Rt Hon Sir Peter
Clark, Dr Michael (Rochford)


Body, Sir Richard
Clark, Sir W. (Croydon S)


Bonsor, Sir Nicholas
Clarke, Rt Hon K. (Rushcliffe)


Boscawen, Hon Robert
Conway, Derek


Boswell, Tim
Coombs, Anthony (Wyre F'rest)


Bottomley, Peter
Cope, Rt Hon John


Bottomley, Mrs Virginia
Couchman, James






Cran, James
Jones, Robert B (Herts W)


Currie, Mrs Edwina
Kellett-Bowman, Dame Elaine


Curry, David
Key, Robert


Davies, Q. (Stamf'd &amp; Spald'g)
King, Roger (B'ham N'thfield)


Davis, David (Boothferry)
King, Rt Hon Tom (Bridgwater)


Devlin, Tim
Kirkhope, Timothy


Dickens, Geoffrey
Knapman, Roger


Dicks, Terry
Knight, Greg (Derby North)


Dorrell, Stephen
Knowles, Michael


Douglas-Hamilton, Lord James
Lamont, Rt Hon Norman


Dunn, Bob
Lang, Ian


Durant, Tony
Latham, Michael


Dykes, Hugh
Lawson, Rt Hon Nigel


Eggar, Tim
Lee, John (Pendle)


Evans, David (Welwyn Hatf'd)
Leigh, Edward (Gainsbor'gh)


Fairbairn, Sir Nicholas
Lennox-Boyd, Hon Mark


Fallon, Michael
Lightbown, David


Favell, Tony
Lilley, Peter


Fenner, Dame Peggy
Lloyd, Sir Ian (Havant)


Field, Barry (Isle of Wight)
Lloyd, Peter (Fareham)


Finsberg, Sir Geoffrey
Lord, Michael


Fishburn, John Dudley
Luce, Rt Hon Richard


Fookes, Miss Janet
Lyell, Sir Nicholas


Forman, Nigel
Macfarlane, Sir Neil


Forsyth, Michael (Stirling)
MacGregor, Rt Hon John


Forth, Eric
MacKay, Andrew (E Berkshire)


Fowler, Rt Hon Norman
Maclean, David


Fox, Sir Marcus
McLoughlin, Patrick


Franks, Cecil
McNair-Wilson, Sir Michael


Freeman, Roger
McNair-Wilson, P. (New Forest)


French, Douglas
Major, Rt Hon John


Gale, Roger
Malins, Humfrey


Gardiner, George
Mans, Keith


Gill, Christopher
Maples, John


Glyn, Dr Alan
Marland, Paul


Goodlad, Alastair
Marlow, Tony


Goodson-Wickes, Dr Charles
Marshall, John (Hendon S)


Gorman, Mrs Teresa
Marshall, Michael (Arundel)


Gorst, John
Martin, David (Portsmouth S)


Gow, Ian
Maude, Hon Francis


Gower, Sir Raymond
Mawhinney, Dr Brian


Grant, Sir Anthony (CambsSW)
Mayhew, Rt Hon Sir Patrick


Greenway, John (Ryedale)
Mellor, David


Griffiths, Sir Eldon (Bury St E')
Miller, Sir Hal


Griffiths, Peter (Portsmouth N)
Miscampbell, Norman


Grist, Ian
Mitchell, Andrew (Gedling)


Ground, Patrick
Mitchell, David (Hants NW)


Grylls, Michael
Moate, Roger


Gummer, Rt Hon John Selwyn
Monro, Sir Hector


Hamilton, Hon Archie (Epsom)
Montgomery, Sir Fergus


Hamilton, Neil (Tatton)
Moore, Rt Hon John


Hanley, Jeremy
Morris, M (N'hampton S)


Hargreaves, A. (B'ham H'll Gr')
Morrison, Rt Hon P (Chester)


Hargreaves, Ken (Hyndburn)
Moss, Malcolm


Harris, David
Moynihan, Hon Colin


Hayward, Robert
Neale, Gerrard


Heathcoat-Amory, David
Needham, Richard


Heddle, John
Nelson, Anthony


Hicks, Mrs Maureen (Wolv' NE)
Newton, Rt Hon Tony


Higgins, Rt Hon Terence L.
Nicholls, Patrick


Hill, James
Nicholson, David (Taunton)


Hind, Kenneth
Nicholson, Emma (Devon West)


Hogg, Hon Douglas (Gr'th'm)
Onslow, Rt Hon Cranley


Hordern, Sir Peter
Oppenheim, Phillip


Howard, Michael
Page, Richard


Howarth, Alan (Strat'd-on-A)
Paice, James


Howarth, G. (Cannock &amp; B'wd)
Parkinson, Rt Hon Cecil


Howe, Rt Hon Sir Geoffrey
Patnick, Irvine


Howell, Ralph (North Norfolk)
Patten, Chris (Bath)


Hughes, Robert G. (Harrow W)
Patten, John (Oxford W)


Hunt, David (Wirral W)
Pawsey, James


Hunter, Andrew
Porter, Barry (Wirral S)


Hurd, Rt Hon Douglas
Porter, David (Waveney)


Irvine, Michael
Portillo, Michael


Jack, Michael
Price, Sir David


Jackson, Robert
Raison, Rt Hon Timothy


Janman, Tim
Rathbone, Tim


Jessel, Toby
Redwood, John


Johnson Smith, Sir Geoffrey
Renton, Tim


Jones, Gwilym (Cardiff N)
Rhodes James, Robert





Riddick, Graham
Taylor, Teddy (S'end E)


Ridley, Rt Hon Nicholas
Tebbit, Rt Hon Norman


Ridsdale, Sir Julian
Thatcher, Rt Hon Margaret


Rifkind, Rt Hon Malcolm
Thompson, D. (Calder Valley)


Roberts, Wyn (Conwy)
Thompson, Patrick (Norwich N)


Roe, Mrs Marion
Thorne, Neil


Rost, Peter
Thurnham, Peter


Rumbold, Mrs Angela
Townend, John (Bridlington)


Ryder, Richard
Townsend, Cyril D. (B'heath)


Sackville, Hon Tom
Tracey, Richard


Sainsbury, Hon Tim
Tredinnick, David


Sayeed, Jonathan
Trippier, David


Scott, Nicholas
Trotter, Neville


Shaw, David (Dover)
Twinn, Dr Ian


Shaw, Sir Giles (Pudsey)
Viggers, Peter


Shaw, Sir Michael (Scarb')
Waddington, Rt Hon David


Shephard, Mrs G. (Norfolk SW)
Wakeham, Rt Hon John


Shepherd, Colin (Hereford)
Waldegrave, Hon William


Shepherd, Richard (Aldridge)
Walden, George


Shersby, Michael
Walker, Bill (T'side North)


Skeet, Sir Trevor
Walker, Rt Hon P. (W'cester)


Smith, Sir Dudley (Warwick)
Ward, John


Smith, Tim (Beaconsfield)
Wardle, Charles (Bexhill)


Soames, Hon Nicholas
Warren, Kenneth


Speed, Keith
Watts, John


Spicer, Sir Jim (Dorset W)
Wheeler, John


Spicer, Michael (S Worcs)
Whitney, Ray


Squire, Robin
Widdecombe, Ann


Stanbrook, Ivor
Wiggin, Jerry


Stanley, Rt Hon John
Wilkinson, John


Steen, Anthony
Wilshire, David


Stern, Michael
Wolfson, Mark


Stevens, Lewis
Wood, Timothy


Stewart, Allan (Eastwood)
Yeo, Tim


Stewart, Andy (Sherwood)
Young, Sir George (Acton)


Stewart, Ian (Hertfordshire N)
Younger, Rt Hon George


Sumberg, David



Summerson, Hugo
Tellers for the Ayes:


Tapsell, Sir Peter
Mr. Tristan Garel-Jones and


Taylor, John M (Solihull)
Mr. Michael Neubert.


NOES


Abbott, Ms Diane
Campbell, Menzies (Fife NE)


Adams, Allen (Paisley N)
Campbell, Ron (Blyth Valley)


Allen, Graham
Campbell-Savours, D. N.


Alton, David
Canavan, Dennis


Anderson, Donald
Carlile, Alex (Mont'g)


Archer, Rt Hon Peter
Carttiss, Michael


Armstrong, Hilary
Cartwright, John


Ashdown, Paddy
Churchill, Mr


Ashley, Rt Hon Jack
Clark, Dr David (S Shields)


Ashton, Joe
Clarke, Tom (Monklands W)


Atkinson, David
Clay, Bob


Banks, Tony (Newham NW)
Clelland, David


Barnes, Harry (Derbyshire NE)
Clwyd, Mrs Ann


Barnes, Mrs Rosie (Greenwich)
Cohen, Harry


Barron, Kevin
Colvin, Michael


Battle, John
Cook, Frank (Stockton N)


Beckett, Margaret
Cook, Robin (Livingston)


Beggs, Roy
Coombs, Simon (Swindon)


Beith, A. J.
Corbett, Robin


Bell, Stuart
Corbyn, Jeremy


Benn, Rt Hon Tony
Cousins, Jim


Bennett, A. F. (D'nt'n &amp; R'dish)
Crowther, Stan


Bermingham, Gerald
Cryer, Bob


Bidwell, Sydney
Cummings, John


Blair, Tony
Cunliffe, Lawrence


Blunkett, David
Cunningham, Dr John


Boateng, Paul
Darling, Alistair


Boyes, Roland
Davies, Rt Hon Denzil (Llanelli)


Bradley, Keith
Davies, Ron (Caerphilly)


Bray, Dr Jeremy
Davis, Terry (B'ham Hodge H'l)


Brown, Gordon (D'mline E)
Day, Stephen


Brown, Nicholas (Newcastle E)
Dewar, Donald


Brown, Ron (Edinburgh Leith)
Dixon, Don


Bruce, Malcolm (Gordon)
Dobson, Frank


Buchan, Norman
Doran, Frank


Buckley, George J.
Douglas, Dick


Caborn, Richard
Dover, Den


Callaghan, Jim
Duffy, A. E. P.






Dunnachie, Jimmy
Hood, Jimmy


Eastham, Ken
Howarth, George (Knowsley N)


Evans, John (St Helens N)
Howell, Rt Hon D. (S'heath)


Evennett, David
Howells, Geraint


Ewing, Harry (Falkirk E)
Hoyle, Doug


Ewing, Mrs Margaret (Moray)
Hughes, John (Coventry NE)


Fatchett, Derek
Hughes, Robert (Aberdeen N)


Faulds, Andrew
Hughes, Roy (Newport E)


Fearn, Ronald
Hughes, Sean (Knowsley S)


Field, Frank (Birkenhead)
Hughes, Simon (Southwark)


Fields, Terry (L'pool B G'n)
Hume, John


Fisher, Mark
Illsley, Eric


Flannery, Martin
Janner, Greville


Flynn, Paul
John, Brynmor


Foot, Rt Hon Michael
Johnston, Sir Russell


Forsythe, Clifford (Antrim S)
Jones, Barry (Alyn &amp; Deeside)


Foster, Derek
Jones, leuan (Ynys Mön)


Foulkes, George
Jones, Martyn (Clwyd S W)


Fraser, John
Kaufman, Rt Hon Gerald


Fry, Peter
Kennedy, Charles


Fyfe, Maria
Kilfedder, James


Galbraith, Sam
Kinnock, Rt Hon Neil


Galloway, George
Kirkwood, Archy


Garrett, John (Norwich South)
Knight, Dame Jill (Edgbaston)


Garrett, Ted (Wallsend)
Knox, David


George, Bruce
Lambie, David


Gilbert, Rt Hon Dr John
Leadbitter, Ted


Godman, Dr Norman A.
Leighton, Ron


Golding, Mrs Llin
Lestor, Joan (Eccles)


Gordon, Mildred
Lewis, Terry


Gould, Bryan
Litherland, Robert


Graham, Thomas
Livingstone, Ken


Grant, Bernie (Tottenham)
Livsey, Richard


Gregory, Conal
Lloyd, Tony (Stretford)


Griffiths, Nigel (Edinburgh S)
Lofthouse, Geoffrey


Griffiths, Win (Bridgend)
Loyden, Eddie


Grocott, Bruce
McAllion, John


Hardy, Peter
McAvoy, Thomas


Harman, Ms Harriet
McCartney, Ian


Haselhurst, Alan
McCrea, Rev William


Hattersley, Rt Hon Roy
McCusker, Harold


Hawkins, Christopher
Macdonald, Calum A.


Hayes, Jerry
McFall, John


Hayhoe, Rt Hon Sir Barney
McGrady, Eddie


Haynes, Frank
McKelvey, William


Healey, Rt Hon Denis
McLeish, Henry


Heffer, Eric S.
Maclennan, Robert


Henderson, Doug
McNamara, Kevin


Heseltine, Rt Hon Michael
McTaggart, Bob


Hicks, Robert (Cornwall SE)
McWilliam, John


Hinchliffe, David
Madden, Max


Hogg, N. (C'nauld &amp; Kilsyth)
Madel, David


Holland, Stuart
Maginnis, Ken


Home Robertson, John
Mahon, Mrs Alice





Mallon, Seamus
Rooker, Jeff


Marek, Dr John
Ross, Ernie (Dundee W)


Marshall, David (Shettleston)
Ross, William (Londonderry E)


Marshall, Jim (Leicester S)
Ruddock, Joan


Martin, Michael J. (Springburn)
Salmond, Alex


Martlew, Eric
Sedgemore, Brian


Maxton, John
Sheerman, Barry


Maxwell-Hyslop, Robin
Sheldon, Rt Hon Robert


Meacher, Michael
Short, Clare


Meale, Alan
Skinner, Dennis


Meyer, Sir Anthony
Smith, Andrew (Oxford E)


Michael, Alun
Smith, C. (Isl'ton &amp; F'bury)


Michie, Bill (Sheffield Heeley)
Smith, Sir Cyril (Rochdale)


Michie, Mrs Ray (Arg'l &amp; Bute)
Smyth, Rev Martin (Belfast S)


Mitchell, Austin (G't Grimsby)
Snape, Peter


Molyneaux, Rt Hon James
Soley, Clive


Moonie, Dr Lewis
Spearing, Nigel


Morgan, Rhodri
Steel, Rt Hon David


Morley, Elliott
Steinberg, Gerry


Morris, Rt Hon A. (W'shawe)
Stott, Roger


Morris, Rt Hon J. (Aberavon)
Strang, Gavin


Morrison, Sir Charles
Straw, Jack


Mowlam, Marjorie
Taylor, Mrs Ann (Dewsbury)


Mudd, David
Taylor, Matthew (Truro)


Mullin, Chris
Thomas, Dr Dafydd Elis


Murphy, Paul
Thompson, Jack (Wansbeck)


Nellist, Dave
Turner, Dennis


Oakes, Rt Hon Gordon
Vaughan, Sir Gerard


O'Brien, William
Vaz, Keith


O'Neill, Martin
Walker, A. Cecil (Belfast N)


Orme, Rt Hon Stanley
Wall, Pat


Owen, Rt Hon Dr David
Wallace, James


Parry, Robert
Waller, Gary


Patchett, Terry
Walley, Joan


Pattie, Rt Hon Sir Geoffrey
Wardell, Gareth (Gower)


Peacock, Mrs Elizabeth
Wareing, Robert N.


Pendry, Tom
Welsh, Andrew (Angus E)


Pike, Peter L.
Wigley, Dafydd


Powell, Ray (Ogmore)
Williams, Rt Hon Alan


Prescott, John
Williams, Alan W. (Carm'then)


Primarolo, Dawn
Wilson, Brian


Quin, Ms Joyce
Winnick, David


Radice, Giles
Winterton, Mrs Ann


Randall, Stuart
Winterton, Nicholas


Redmond, Martin
Wise, Mrs Audrey


Reid, Dr John
Worthington, Tony


Richardson, Jo
Wray, Jimmy


Roberts, Allan (Bootle)
Young, David (Bolton SE)


Robertson, George



Robinson, Geoffrey
Tellers for the Noes:


Robinson, Peter (Belfast E)
Mr. Allen McKay and


Rogers, Allan
Mr. Adam Ingram.

Question accordingly agreed to.

Clause 12

THE DENTAL ESTIMATES BOARD AND THE SCOTTISH DENTAL ESTIMATES BOARD—CHANGE OF NAME AND EXTENSION OF FUNCTIONS

Lords amendment: No. 21, in page 13, line 3, leave out from first "to" to end of line 6 and insert
carry on any such additional activity relating to the provision of general dental services as may be prescribed and, without prejudice to the generality of this subsection, to conduct or commission surveys or other research relating to the provision of such services.

Mrs. Currie: I beg to move, That this House doth agree with the Lords in the said amendment.
This technical amendment was accepted in Committee in another place. It ensures that the wording of subsection (3)(b)(1C) is sufficiently wide to allow sensible research activity on the general dental services to be undertaken by dental estimates boards. The amendment clarifies the position and removes any unintended inflexibility.

Question put and agreed to.

Clause 13

GENERAL OPHTHALMIC SERVICES AND OPTICAL APPLIANCES

Lords amendment: No. 22, in page 13, line 18, leave out subsection (1).

Mr. Kenneth Clarke: I beg to move, That this House doth disagree with the Lords in the said amendment.

Mr. Speaker: With this it will be convenient to take the following:

Amendments (a) to (f) to Lords amendment No. 22.
Lords amendment No. 23.
Amendments (a) and (b) to Lords amendment No. 22.
Lords amendment No. 26.
Amendments (a) to (f) to Lords amendment No. 26.

I remind the House that privilege is involved in these amendments.

Mr. Clarke: Lords amendment No. 22 deals with the question of whether we should introduce charges for eye tests as a contribution towards the Health Service's rising expenditure.
We have just had a rather closer vote than those to which we are accustomed—[Interruption.]

Mr. Speaker: Order. Right hon. and hon. Members who remain beyond the Bar must be quiet or should enter the Chamber.

Mr. Clarke: There is a certain degree of excitement in the House, and we have just had a very rousing winding-up speech from my hon. and learned Friend the Minister of State, Department of Health. We have had some exchanges with our own right hon. and hon. Friends as well as with Opposition Members on exactly what the divisions are about this evening.
We are engaged in a very serious matter that has considerable consequences for the Health Service. I listened to a good part of the last debate. I heard, for example, my hon. Friend the Member for Reading, East (Sir G. Vaughan), a distinguished former Minister of Health and a personal friend of mine, speak extremely eloquently about the problems of oral cancer. He touched on the subject of eyesight and spoke also about glaucoma.

I accept entirely the sincerity with which he spoke. I also know that he realises that both my hon. and learned Friend the Minister of State and myself are equally concerned about the problems of oral cancer and glaucoma.—[Interruption.] Of course we are. The suggestion that we are oblivious to those matters has arisen. In the previous debate, there was a difference between us as to whether a £3·15 charge every six months will deter anybody from examinations that might in a few cases give rise to the discovery of oral cancer.
What also runs behind this debate are the finances of the National Health Service for next year. What happens as one progresses in a debate of this kind is that everyone rather warms to his theme. Certainly I find myself warming to my theme and becoming ever more convinced of my case. I suspect that some of my right hon. and hon. Friends and Opposition Members are growing ever more convinced of theirs.
The House has just given us a rather close run thing that might have cost the Health Service £50 million in the coming year. I find it ironic and perverse that on a day when we have provided over £2 billion more for the Health Service over and above last year's spending, and over and above last year's settlement, the Labour party is voting to take funds out of the Health Service and to try to knibble away at that increased expenditure. My hon. and learned Friend was quite correct in saying in the previous debate that hon. Members on both sides of the House spoke of £50 million as though it were a small sum, although at least one of my hon. Friends was talking about more than the complete budget of his district health authority. Both my hon. and learned Friend the Minister and I gave examples of the kind of treatment that can be provided out of such sums.
10.30 pm
I respect the sincerity of hon. Members of both sides, but they are not addressing themselves to the fact that by voting as they do they are denying patients throughout the country the prospect of treatment. In this debate, no doubt I shall be told that we are—[Interruption.]

Mr. Speaker: Order. I ask hon. Members not to address remarks to me, or to anyone else, from a sedentary position.

Mr. D. N. Campbell-Savours: Get to the business.

Mr. Clarke: The hon. Member says, "Get to the business." I am getting to the business of the £70 million against which he is about to vote and which will deprive people in Workington and elsewhere of an expansion in services that might otherwise take place. That is highly relevant to the next debate, and he and others should bear it in mind.
I make no apologies for reminding the House of that background. It is against that background that I shall listen again to the arguments that will be adduced about the possibility of undetected glaucoma if we do not vote against the prospect of the most prosperous 60 per cent. of the population—those who do not fall into the exempt categories—facing a horrendous bill of up to £10 every two or three years. [Interruption.] Yes, I am angry, because we are facing—[Interruption.] The Labour party is again


being irresponsible about health charges. If the House becomes irresponsible, we shall be £70 million light for the Health Service and treatment expansion next year.

Mr. Campbell-Savours: rose—

Mr. Speaker: Order. The Secretary of State is not giving way.

Mr. Clarke: I may give way in a bit, but I will not be interrupted from a sitting position by the hon. Member for Workington and then give way to him two minutes later.
The issue in this debate will turn on whether people will be deterred from going to the optician and cases of glaucoma will not be detected if we introduce the charges that we are suggesting for the sight test. That is the nub of the debate. Before we launch into long descriptions of the consequence for eye disease, we must first ask how many people, if any, will be deterred from going to the optician by the prospect—and it is no more than a prospect—that many opticians will charge £10 or thereabouts.
I said when I spoke about dental charges that we had heard the argument about deterrence year in and year out for more than 10 years, every time we raised the charges. We have had exactly the same experience with the optical services. But, as many hon. Members will remember, we had a more serious debate about optical services about four years ago when we took the dispensing service out of the NHS and introduced the voucher scheme. We made significant changes in the way in which the NHS was financed.
At that time exactly the same arguments were adduced. We were told that there would be undetected disease and sight problems. I recall those debates quite well. I have seen briefing quoting some of the comments that I made in that debate. I have re-read the debate. The then spokesman for the Labour party, the hon. Member for Oldham, West (Mr. Meacher), said on 20 December 1983:
The result for the public will be eye strain and headaches at best. At worst it will be the inability to see clearly so that they are at risk in their work, a hazard in the road or otherwise may injure themselves".—[Official Report, 20 December 1983; Vol. 51, c. 306.]
We heard all the stories of glaucoma, we heard about bus drivers driving into lamp posts and how the price of spectacles would soar as we privatised the service.
The evidence supports the arguments which I used before and which go to the root of the debate. We have heard this cry of wolf before. It did not happen. The changes that we made did not result in fewer visits to the optician. In fact, competition made spectacle prices more reasonable and the choice to the consumer was extended. According to the most recent survey that I have, the United Kingdom's retail sale of spectacles increased by about 10 per cent. in the first two years alone— from 1984 to 1986.
Therefore, all those arguments proved to be false. Greater use is being made of the optical services than was made before we made the changes which were opposed on precisely the same grounds as our proposals are being opposed today at a threatened cost to the National Health Service of £70 million.

Mr. Ian Bruce: Does my right hon. and learned Friend realise that this House did away with free eye tests before? Before we had the National Health Service, opticians gave free eye tests. At the moment the

taxpayer pays for eye tests. Does my right hon. and learned Friend agree that we are likely to get free eye tests again because of economic and commercial pressures?

Mr. Clarke: I agree with my hon. Friend. I shall turn tohis point in a moment.
The people who campaign against us now campaigned against us four years ago. They are better off than they were then, although at the time they feared that they would be made poorer. The public are making more use of the optical services than they did then.
We are now discussing the idea that the six out of 10 of the population who are not exempt will be deterred by having to pay £10, typically about every two or three years. I shall not rehearse all the arguments I used about dental examinations as to why I think that that is contrary to common sense as well as the evidence.
I keep being challenged, "Who in the profession agrees with you?" I have never found that large numbers of turkeys rush forward before Christmas, but I have found some support from sensible journals. I propose to assist the House by reading from the column known as Nemo which, as hon. Members who follow optical matters will know, appears in Optician of 1 January 1988. It deals directly with the core of the debate—whether people will go to the optician with less frequency because of the charges. I shall read from Nemo because I have been challenged to produce support from people within optics —having found one, I shall read it— [Interruption.] As my hon. Friend the Member for Dorset, South (Mr. Bruce) said, if the House agrees with their Lordships, opticians expect to continue to be paid by the taxpayer for a service which otherwise they would provide free. There is no doubt as to who the beneficiaries will be if we agree with their Lordships in the amendment.
Optician said:
if it is to have any effect in the place where it matters, the case against the Government's proposals needs to be presented in well reasoned and dispassionate terms, avoiding as far as possible dire predictions and the sort of sweeping and unsubstantiated allegations normally resorted to on such occasions. What reason is there for supposing that to ask people to pay for something previously provided free will cause them to lose interest in the particular goods or services, particularly where their health is concerned? To incline to this view is surely to underestimate the intelligence and sense of responsibility of the man in the street.
The audience of this journalist are opticians.
Is it really asking too much to require persons in work or who are otherwise able to pay, to fork out, say, £10 for a sight test every two years? Let us retain a sense of proportion; this represents no more than the cost of a couple of modest rounds of drinks, or a single restaurant meal.
Contrary to what the pundits would have us believe, one tends to learn more from the experience of history. Those who are old enough, for example, will recall how the imposition of the first NHS charges in the early 1950s was interpreted by the Cassandras as the death knell for opticians. The reality, of course, was that people still had need of spectacles—and have demonstrated their willingness to pay for them to an ever-increasing extent over the years.
The end of NHS dispensing in 1985"—

Mr. Canavan: Reading.

Mr. Clarke: Of course I am reading—I am quoting. The hon. Member last emerged in the Chamber to chant in a similar way at one of my hon. Friends. I trust that he will not continue to do that throughout the debate. I have already told one of his hon. Friends that a lot of money forthe Health Service is at stake.
The end of NHS dispensing in 1985"—

Mr. Canavan: Reading.

Mr. Clarke: I am quoting.
The end of NHS dispensing in 1985—

Mr. Canavan: Reading.

Mr. Clarke:: —
proved a further testing time—

Mr. Canavan: Reading.

Mr. Clarke:: —
for the prophets of doom,—

Mr. Canavan: Reading.

Mr. Clarke: —
when, contrary to all predictions, little or no falling off in public demand—

Mr. Canavan: Reading.

Mr. Clarke: —
for opticians' services occurred following

Mr. Canavan: Reading.

Mr. Speaker: Order.

Mr. Clarke: —
the ending of their sales monopoly. On this evidence there seems little to fear regarding the public's longterm willingness—

Mr. Canavan: Reading.

Mr. Clarke: —
to pay reasonable sums also for sight tests.

Mr. Churchill: rose—

Dame Jill Knight: rose—

Mr. Clarke: —
The real problem for the ophthalmic optician will be to try to ensure—

Mr. Canavan: Reading.

Mr. Clarke: —
that his is the chosen establishment for this purpose, and not that of a competitor.

Mr. Churchill: rose—

Dame Jill Knight: rose—

Mr. Speaker: Order. Let us have all the points of order together then.

Dame Jill Knight: On a point of order, Mr. Speaker. Is my right hon. and learned Friend not perfectly entitled to read a quotation if that is what he wants to do? I for one am anxious to hear what he says.

Mr. Speaker: The whole House is anxious to get on with this debate.

Mr. Clarke: I am grateful to my hon. Friend. She and I address ourselves seriously to this issue. I do not think that people outside will be very pleased to hear that we are talking about this sum of money for health care against a background of din from the hon. Member for Falkirk, West (Mr. Canavan), who has just joined us.
I have quoted Optician, setting out in reasonable terms, which I shall not attempt to repeat or embellish, the underlying case of people who follow the affairs of the optical world much more than most hon. Members and

their fears on costs. We must ask whether opticians will impose a charge which will deter the six out of 10 of the population who are not exempt from charges.
How much will opticians charge? One proposition is that they will continue to charge what they at present charge the NHS, which is about £10. The Bill would end the provision of an NHS test for non-exempt people. Opticians will charge what they decide to charge. If the Government are successful in this Division, it will be for opticians to determine what, if anything, is charged to their customers or patients.
Much of the debate, in this and the other place, has been founded on the proposition that all opticians will continue to charge the equivalent of the NHS fee that they now get for the free sight test which they offer to everyone. Some of my hon. Friends who know just as much about the optical profession as I do disagree with me. This is a matter of opinion and judgment. I do not believe that all opticians will maintain a charge for a sight test which is equivalent to the present NHS fee that they receive, for the same reason that the cost of spectacles did not soar when we withdrew NHS glasses four years ago. Competition —a legitimate activity for professional people, as for others—will oblige opticians to offer a charge for optical tests—if they charge at all.
10.45 pm
I ask the House to consider the other argument against me. I know that I shall hear this point: "No, we have asked all the opticians and they all say that they will carry on charging what they get at the moment from the NHS. That will deter the clientele. We shall sit around and watch the eye disease develop which would otherwise have been detected." Does that mean that these commercial men—all professional men are business men as well as qualified people—will solemnly all set the same fee, at a level which deters customers from coming over the threshold of their shops? They will all sit around watching their incomes drop as fewer patients come in— [Interruption.']

Mr. Hayes: rose—

Mr. Clarke: Before my hon. Friend again starts telling me that this is peanuts— about four and a half times the budget of his health authority—let me say that I have history on my side. I told the House four years ago that I did not believe those people then, and I was right. Frankly, I do not believe them now.

Mr. Robert McCrindle: My right hon. and learned Friend is spending a good deal of time in likening the proposed charges to past examples. Does he agree that there is a fundamental difference in one area to which he has not so far directed his attention? Those of us who are concerned about the Government's proposal are not just concentrating on the poor, as perhaps we did in the past. We are looking at people who, for no other reason than that they are over a certain age, begin to develop sight defects. If there is a deterrent to those people—a large number of whom will not fall within the category of poor—and they do not seek an eye test, the savings on which my right hon. and learned Friend concentrates will be swamped by the additional resources that will have to be devoted to diseases if and when they arise.

Mr. Clarke: I respect my hon. Friend's views. He is returning to the key of the argument. He asserts, contrary


to what I have just said, that these charges will continue to be levied, despite the competitive pressures on opticians—

Mr. Denis Howell: Of course they will.

Mr. Clarke: I do not think that the right hon. Gentleman spoke when we last talked about opticians, four years ago.
My hon. Friend the Member for Brentwood and Ongar (Mr. McCrindle) is entitled to disagree with me. He disagrees with my instinct, my opinion, that opticians will not maintain eye test charges for very long. If they do not maintain eye test charges, my hon. Friend's fears will be ill-founded, as he will concede. He says that, if opticians maintain some eye test charges, that will deter the elderly in particular. I am sure that he agrees that not all pensioners fall into the poor category, but I agree that the older one becomes, the more one is prone to glaucoma.
I concede that I may be wrong in my opinion that the charge for the eye test will steadily disappear, but that is my strong personal opinion. Let us imagine that some charges are maintained at anything up to about £10, which is what opticians get for the NHS test now. We can then examine what I first anticipated would happen. Every couple of years or so, people might face the prospect of having to go to the opticians. At the moment, people who go to opticians usually expect to pay for their spectacles, if they are not exempt. They are right to do so. The reason why people usually go to the opticians is that they are not seeing as well as they used to, or need to have their prescriptions updated. Three out of four people who go for a sight test wind up acquiring spectacles. And they pay for them. The charges they pay for the glasses are considerably higher than any possible deterrent arising from these charges.
We have found since privatisation that people are not deterred, as I have already said, by the prospect of going through the voucher scheme or paying for themselves. NHS voucher customers who qualify for help have in practice been willing to pay more than their vouchers for the spectacles of their preference. Even though such people are, by definition, of modest means, it is not surprising that they are willing to top up their NHS vouchers to pay for what is not a huge or recurrent item of expenditure. Most pay now; most will in future.

Dr. Keith Hampson: Does my right hon. and learned Friend agree that the competitive pressure on opticians will depend entirely on where they are—that is, on whether they are in major town centres or small towns?
Does my right hon. and learned Friend accept that this is not a matter of creating a further disincentive to those who already use eye tests? Every Government Minister accepts and preaches that there is not enough take-up of screening of all kinds, and that we should encourage more take-up.
In the context of the remarks made earlier this evening by my hon. and learned Friend the Minister of State, what is the real difference between screening for cancer and screening for eye ailments and other diseases?

Mr. Clarke: I shall deal first with the argument that competition may not occur everywhere. My hon. Friend the Member for Boothferry (Mr. Davis) pointed out in

conversation with me that competitive pressures may not exist in rural areas. But, even in rural areas, I cannot believe that opticians will be too far away from other opticians for such pressures not to exist. Although they may have a slightly protected market, they will not sustain their position if it is clear to their rural customers that in nearby towns such as Leeds or Hull there are no charges for a test. [Interruption.] Already one can see those little signs in the windows of opticians' premises saying, "Free NHS tests here". I do not criticise opticians for that: it is a way of getting customers across the threshold to sell them spectacles, if it turns out on examination that they need a prescription.
Secondly, my hon. Friend mentioned screening tests. My hon. and learned Friend the Minister of State was right to challenge the direct comparison with full-blooded screening. We are not talking about cervical cancer or breast cancer screening. Both those tests are expressly designed to show whether the first signs of a particular condition are present. We are discussing average patients going for eye tests to see whether they need spectacles, or going to the dentist to see whether they need treatment —[Interruption.] What I have said is correct. [Interruption.]

Mr. Speaker: Order. Hon. Members will have an opportunity to participate later in the debate, but not by intervening in this way.

Mr. Clarke: What happens—and neither I nor my hon. and learned Friend denies this—is that it gives an opportunity to someone who is examining for a particular purpose to detect the first signs of other diseases. However, it is not a specific screening test. The idea that eye tests were invented for the purpose of detecting glaucoma is nonsense. This Government introduced and financed breast cancer screening to detect avoidable disease and breast cancer in women. The eye tests merely offer an opportunity for people to detect glaucoma.
Of course, we must not take risks. Most of my hon. Friends and Opposition Members have listened patiently while I have explained why I do not agree that patients will be deterred, nor even convinced, that the charges will be maintained. My hon. Friend the Member for Leeds, North-West (Dr. Hampson) and others ask, "Why take the risk?" My hon. Friend is obviously worried about the risk of glaucoma going undetected if my judgment, based on experience of optical charges, turns out to be wrong. This measure has been through this House several times and I and my hon. Friends have gone to great lengths to cover that risk. I have already said that it is my opinion that no great risk exists and that people will not be deterred from having eye tests.
I began my speech by saying that I am no more anxious to have avoidable disease in this country than is my hon. Friend the Member for Reading, East or any other hon. Member. At earlier stages we have made concessions that provide a free NHS eye test for those groups most at risk. Glaucoma is estimated to affect about 1 to 2 per cent. of those over the age of 40, a proportion of whom do not wear glasses. There is a much higher risk among particular people as there is a hereditary element in the condition of glaucoma. People of 40 or over who are the siblings and children of the glaucoma patient are at 10 times greater risk of developing the condition than those who are not so related. That is why my right hon. Friend the Chancellor


of the Duchy of Lancaster, then the Minister for Health, proposed to retain the free NHS eye test for that group, which is most at risk.
We have already proposed to retain the free test for those suffering from diabetes. Contrary to what I believe to be necessary, there have been concessions, in case we are proved to be wrong, to cover that section of the population most at risk. Yet, having gone to such lengths, hon. Members now say, "No, there must be a free eye test for everyone in this Chamber and everyone in the high income groups, including those in the higher tax bands, in case the opticians continue to charge."
I believe that the practical effect of these proposals is that the opticians will continue to have an income from the NHS that they would not otherwise get. Most important, the NHS—on the night of the day when my right hon. Friend has given a great deal more money to it—will have to take £70 million out of its planned expenditure if this amendment is not carried.

Mr. Hayes: I am sort of grateful to my right hon. and learned Friend. He said that he was taking a risk—it is more like backing a whippet with a wooden leg. Some 70 per cent. of optometrists' income comes from the sight test. What will happen to the other 30 per cent.? It will be loaded on to the price of spectacles and contact lenses.

Mr. Clarke: I invite my hon. Friend to raise the subject of optometrists' incomes in his speech, and I shall deal with it when I reply to the debate. That is what I think to be at risk if their Lordships' decision is overturned by this House. I think that the most competitive optometrists, the best opticians, those who continue to build on the success of the past four years when there has been a growth in spectacle sales, will do very well.

Mr. Hayes: No.

Mr. Clarke: My hon. Friend obviously knows some less competitive optometrists who rather like the idea that the NHS should continue to pay them £10 a time for everybody who comes through the door to whom they give a sight test. If he wishes to pursue that argument further —which he did not set out in his Evening Standard argument—my hon. and learned Friend the Minister of State will be only too anxious to give him as good as he gets in the course of the exchange.

Sir Giles Shaw: rose—

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Mr. Clarke: This must be the last intervention because I wish to conclude my remarks.

Sir Giles Shaw: Will my right hon. and learned Friend clarify the position of a glaucoma test in the NHS testing procedure? Is there no requirement for such a test to be conducted when a person goes for a normal NHS sight test? Is there any way in which it can be enforced so that when we have—if my right hon. Friend's argument is persuasive—a £10 charge for it, at least the public will know that the test for that disease will be a part of the NHS eye test?

Mr. Clarke: My hon. Friend raises a serious point. I believe that the bulk of responsible optometrists and

opticians give a full sight test—[Interruption.]—and we have the powers to specify the extent to which the patients and customers are tested. We shall look at the necessity to use them if we find that people are giving quick sight tests and not screening for glaucoma. [Interruption.] Labour Members are disappointed by that, it seems. They have come to life again, their Scottish hon. Friend the Member for Falkirk, West (Mr. Canavan) having gone back to where he came from prior to joining us for our discussion. What I said is important and is relevant to the detection and treatment of glaucoma.
Most of the arguments that we are about to hear in this debate, I anticipate— though I shall listen, as ever, with an open mind—will not touch on the detection and treatment of glaucoma. If some passion is to enter the debate, let us ensure that in making a judgment in the next hour or two we do not put at risk £70 million which I and my hon. Friends want to put to use in the NHS, including in the optical services.
Rebellion requires more courage and conviction than routine opposition. Tonight Labour Members are indulging in routine opposition. When my hon. and learned Friend the Minister of State teased them about whether they would like to see the end of all health charges, a big cheer came from them. Apparently they are saying that they would abolish all health charges. That would mean huge expenditure for no benefit to the patients. It also means that they are committing themselves to a policy which, as we know perfectly well, they would never implement if they ever got to power.
If we succeed in overturning this Lords amendment, I do not believe that any future Labour Government will ever withdraw this charge for the optical examination or will bring it back—because I do not think there will be a charge —for the sake of paying the opticians a fee, which by then will have disappeared or be very cheap indeed by the forces of competition.
Labour Members are being opportunistic. They are taking advantage of an occasion when my hon. Friends are concerned about eye disease. There are serious issues at stake, such as the future of the Health Service, its expanded services next year and keeping the full benefit of the £2·2 billion that we have put in. I ask my right hon. and hon. Friends to vote to ensure that we keep the full benefit of all that extra money.

Mr. Robin Cook: It would be churlish of me to begin without congratulating the Secretary of State on having found one medical view in support of his proposal, albeit one who felt compelled to write anonymously.
The right hon. and learned Gentleman said that he believed that he was absolutely right those were his words—in the views he expressed in the House on 20 December 1983, when we last debated this matter. Let me remind the Secretary of State of what he said in the speech in which his remarks were "absolutely right". He said:
We are keeping in the NHS what should be kept there—free sight tests for everyone, regardless of need."—[Official Report, 20 December 1983; Vol. 51, c. 362.]

Mr. Kenneth Clarke: I am glad that the hon. Gentleman has got round to the House of Commons brief; I trust that he has also looked at the copy of Hansard from which that quotation is taken. Before he comes to the quotations from my right hon. Friend the then Secretary of State for Social Services, I would point out that when the quotations are taken in context it is clear that we were describing the then


measure and the then measure kept the eye test in the National Health Service. The charge for it was not at issue in the explanation of the deregulation. [Interruption.] The hon. Gentleman has not read Hansard. [Interruption.] I am merely asking hon. Members to stop quoting selectively. If the hon. Gentleman reads the debates in March 1983 he will find that the hon. Member for Holborn and St. Pancras (Mr. Dobson) helpfully intervened to underline the point that I made in Committee. I described the arrangements as being in place for the time being, and my remarks are on record. There is no inconsistency in what we are saying today.

Mr. Cook: It was as well that we let the Secretary of State intervene, and continue for as long as he did. I listened with great care to his concluding remarks. He said that he had made it clear—of course, he is quite right—that his commitment to free sight tests was "for the time being". Those are precisely the words that he used earlier when he said that this Government had no plans to introduce charges for cervical cancer smears, breast cancer examinations or visits to the doctor. That, too, was "for the time being." We now have a clear definition of what "for the time being" means: it is a period of four to five years at the outside.
The Secretary of State is perfectly entitled to change his mind. It is open to any hon. Member to do so. However, I put it to him that some people who heard what he said in the debate in 1983 have not changed their minds and believe that free sight testing ought to remain in the NHS. If I may say so—as one colleague to another—the Secretary of State is not entitled to get angry with those who have not changed their mind with the same facility as he has. There are serious and deeply held views on sight tests on both sides of the House and those views will not be changed by a display of ill temper.
All the arguments of principle in the previous debate can be carried forward into this second debate. The House will he relieved to hear that I do not propose to repeat those arguments. However, I firmly believe that the case against charges applies with even greater force to the eye test.
There are two reasons for that. The first is the nature of the examination. In preparation for the debate, I went for an eye examination. Some hon. Members may know that, having observed photographs which perhaps do not show me at my best. Any hon. Member who has been through the test must know that it is misleading to describe it as a sight test. It is a full examination of the eye. The eye is the one part of the body behind which one can look without cutting it open. It is a window through which one can see not just the ocular system but the circulatory system and the immediately adjacent part of the brain. That has been admitted by the Secretary of State and the Government, who have tabled an amendment seeking to exempt those suspected of suffering from glaucoma and diabetes. That is a very clear indication of the fact that the eye examination is an effective way of screening for those very serious diseases.
Other diseases may also be detected. Twice as many cases of hypertension as cases of diabetes are detected through the eye examination. Since the debate began a year ago, when the Government first floated their proposals, my hon. Friends the Members for Aberdeen, South (Mr. Doran), for Fife, Central (Mr. McLeish) and for Wigan (Mr. Stott) have all been visited by constituents

who have made it plain that their lives had been saved by a routine eye examination in which a serious tumour requiring urgent operation had been detected. It is not an isolated and rare occurrence; one in 12 eye examinations results in a medical referral. That is 1 million cases a year. To put it another way, three out of four cases of glaucoma are first detected during eye examinations. Those matters are not in dispute. The Green Paper said that sight tests can identify health problems as well as a need for spectacles. Therefore, it is important that skilled sight testing should remain readily available. That is important.
As I understand the Government's case, they do not deny the importance and the significance of the eye examination. What the Secretary of State has argued is that, yes, eye examinations are important, but nobody will be deterred if we take away the fee that we pay to optometrists and they in turn introduce a charge. I find it curious that a Government as committed as this Government are to market forces—in all other areas holding that the price signal is effective—should in the solitary case of health charges suspend the law of market economics and say that the price signal does not deter. It is nonsense on stilts for them to sustain that no one would be deterred by "a tenner a test".
I listened with interest to the Secretary of State when he talked about how much the test would cost. I believe that he would agree that one could fairly sum up his comments by saying that, after this measure has been passed, we shall have no control over what the charge might be. We are abandoning the charge to the optometrists. In a sense, this debate is even worse than the previous one, because at least then we knew how much the charge would be. On this occasion, the Secretary of State maintains that the charge could be less than £10. Equally, it could be more than £10. I am bound to say that every optometrist I have met during the past year has made the obvious and simple observation that he is likely to have fewer people coming forward and, if he is to sustain the same amount of income, he will have to charge more than £10 a test.
We now have evidence—which was not available on Report—of what happens when the fee is withdrawn and it is left to the market to decide. It is sufficiently dramatic to justify a retrial. That evidence comes from the state of Alberta. In August 1987 the state eliminated free eye tests by withdrawing them from state insurance. The result was so disastrous that it brought back free eye tests within 11 months. Lord Skelmersdale was unfortunately caught adrift when the other place debated this measure, and he was unwise enough to say that the report of things going wrong in Alberta was merely anecdotal. He was unaware that in the same month in which he referred to those difficulties as being anecdotal the government of Alberta had been so convinced by the reality of its experience that it was bringing back free sight tests. The abolition of free sight tests in Alberta did not reduce examination charges, but resulted in charging by optometrists. It is claimed that abolition produced a drop of 30 per cent. in the number of people presenting themselves for eye examination. Another consequence was that there was a sharp increase in the number of people being referred to eye hospitals for a more expensive eye examination.
That brings me to the second reason why on this issue the case against charges is stronger. The Secretary of State repeatedly told us that he was doing this for the money and, to be fair to him, he made no bones about that. In that spirit of candour, I will respond by saying that he will


get more money by charging for dental examination, but, in so doing, he will cause great damage to the teeth of the people of this nation—damage which is not worth £49 million. I accept that he will get the money from dental examination fees. I do not believe for one moment that he will find himself in pocket as a result of abolishing free eye tests. He will not get any money from this perverse measure and I will give two reasons why that is so.

Mr. Michael Grylls: The House is listening carefully to the hon. Gentleman's arguments. I am certainly trying to do so. Is it not wrong to talk about "free" eye tests? Surely what we are arguing about—this is a perfectly reasonable argument—are eye tests that are provided by the generality of taxpayers—they are certainly not free—and eye tests provided by a free and competitive market. Is it not our experience in most aspects of life that the operation of a free market where there has never been one before, which is what there will be if this measure is agreed, will serve the public better?

Mr. Cook: I have some sympathy with the hon. Gentleman's point. Ultimately the eye test is not free. Ultimately it has to be paid for by somebody. At present, it is paid for by the taxpayer. What I find curious about the Secretary of State's argument is that he seemed to have invented the free sight test for which the taxpayer would not pay and nor would anybody else. Plainly, that does not stand to reason. The Secretary of State cannot save £90 million unless somebody else pays for it.
I predict, with confidence, that the Secretary of State will not save that sum, for two reasons. The first is a short-term reason. Our eye hospitals will be swamped by references from general practitioners who will no longer be able to refer their patients to optometrists for free examinations. They will be able to secure free tests for their patients only by referring them to an eye hospital. That is what many general practitioners will do. The Secretary of State has come up with a proposal which gives everybody an incentive to go for their eye examination to the one place where it costs the right hon. and learned Gentleman the most to pay for it and to avoid the optometrist round the corner, where it would cost him least to pay for it.
The long-term reason why I do not believe that there will be any savings from this proposal is even more disturbing. As a result of the removal of the free sight test there will be a growing burden on the Health Service from people with serious medical conditions which will not now be detected until they are at an advanced stage.
It is possible to extrapolate from the experience of Alberta what that could mean for primary care in Britain. There are 12 million eye examinations in Britain every year; 70 per cent. will now be liable for a charge—that is 8·5 million. If 30 per cent. of those cases in Britain are deterred by a charge—as happened in Alberta—2·5 million people will not go for an eye examination. If the instances of glaucoma among that 2·5 million is the same as that for the population as a whole, we will miss 10,000 cases of glaucoma annually. We may miss another 10,000 cases of diabetic retinopathy. Glaucoma cannot be reversed. It can be arrested, but when it has proceeded to too advanced a stage, it cannot be reversed. When it is found too late, the sufferers are going blind.

That is not just a personal tragedy for the people concerned. If I may put it in terms to which the Treasury can relate, it will also be expensive for the NHS. Every blind person costs the state £3,500 per year in added services. The annual cost for 10,000 cases of glaucoma which are not detected in time would wipe out half the savings that the Secretary of State hopes to achieve by abolishing the free sight test. He is not making a saving. He is taking on an expensive commitment to future care. The truth is that the free eye test is not a burden; it is a bargain. Only those who can see only the bottom line on costs or those who overlook the importance of the sound principle that preventive screening should be free can overlook the excellent cost benefit that the free eye test represents.
I come now to the heart of the matter. In the past few days, we have seen high drama on whether the Secretary of State will succeed in facing down his hon. Friends the Members for Birmingham, Edgbaston (Dame J. Knight) and for Harlow (Mr. Hayes). Twice in one night the Secretary of State has taken on not only the Opposition but a large wing of his Back Benches. It is inconceivable that any man so urbane and well-rounded as the Secretary of State would go to all this trouble for the modest sum that he hopes to save. It is impossible that a man of his intelligence even believes that he will save any money from this proposal.
No Minister goes to all that trouble over such a doubtful prospect, but he may go to it for the sake of principle. I fear that the reason why the Secretary of State is taking on all-comers over this issue is the principle that, if the House swallows this proposal, it will swallow the principle of charges for any form of primary care treatment. All that is left is to decide what comes next—charges for a visit to the doctor, for cervical smears and for breast screening.
I end by coming to the point where Opposition Members differ from the dissenters on the Conservative Back Benches. We agree with them in opposing the proposal because it will be deeply damaging to the nation's health, but we also oppose it on grounds of principle, because we are committed to a Health Service open to all and free at the time people need it. It is in defence of that principle that we shall vote against the Government.

Mr. John Marshall: Much of what we have heard today has been predictable. Whenever the Labour party is in opposition and Health Service charges are mentioned, Labour Members have a knee-jerk reaction. In 1964, the Labour party promised to abolish prescription charges. By 1970, prescription charges had not been abolished, but were higher than they were in 1964. In 1974, the Labour party campaigned on a promise of abolishing prescription charges. By 1979, they still existed. I am willing to wager that, whatever they have said tonight, Labour Members will campaign in election after election promising to abolish these charges and then doing nothing about it, if they ever, by some mischance, find themselves in government. They have led the country down that path before, making promises and then not keeping them, and that is what they would do about these charges.
Much of the discussion about these charges is pure synthetic indignation. A charge of £10 to be met every second year is equivalent to giving up two cigarettes a week; how much better it would be for people's health if they gave up the whole lot rather than just two a week. Can people really say that no one can afford a charge of £10


every second year when the average industrial wage is £224? When I asked the Liberal party spokesman, the hon. Member for Southport (Mr. Fearn), about this, he said that there were people below the average industrial wage. Of course there are, but those who are poor and those with low incomes will not be paying prescription charges.

Mr. Peter Fry: Will my hon. Friend give way?

Mr. Marshall: No, I shall not give way. I promised to be brief and I shall be.
We are discussing a charge that will raise £70 million at a time when this country spends £2,458 million a year on betting and gaming. Are we saying that a society that can afford to spend that amount of money on betting and gaming cannot afford to spend £70 million on eye tests?
We are told that the charge will definitely be £10. We even had the absurd suggestion from the hon. Member for Livingston (Mr. Cook) that, because some people might not have a test, the opticians' reaction would be to put up the price, but he confessed to some doubts about market economics. I can assure him that there is no market place in the world where the supplier of a service reacts to a reduced demand by putting up the price. If he were to take a first-year course in elementary economics, he would be told that a reduction in demand leads to a reduction in price. Wherever one goes in our towns and cities, one sees competition among opticians in the main high streets. I am willing to wager that, when these charges are introduced, we shall find an optician in every town offering a free National Health eye test. As soon as one optician takes that step, the optician down the road will take it. Competition will ensure that the £10 charge will not increase, as Labour Members suggest, but decrease.
We must consider the proposed charges as part of a package that will lead to better primary health care and a better Health Service. We must ask ourselves whether it is right that those who can afford to pay a modest charge should receive a free service.

Mr. Fry: My hon. Friend is saying that those who can afford to pay should pay. I have much sympathy for that view, but has he considered the position of pensioners who do not pay income tax and receive no benefit from the state apart from their basic state pension? They will not be able to afford a charge of £10. What will be their position?

Mr. Marshall: My right hon. and learned Friend the Secretary of State made it clear this afternoon that someone who is in receipt of the basic pension will be in a better position than my hon. Friend imagines. Those who take a Rip Van Winkle view of life, suggesting that every pensioner has merely a basic pension and that there should be free eye tests for all those of pensionable age, are suggesting that Sir Robin Day, for example, should be given the right to enjoy a free eye test. What would people do to try to get on "Any Questions" on a Thursday night? It is surely not a correct sense of social priority to seek to provide free eye tests for Sir Robin Day at the expense of the general body of taxpayers, many of whom earn much less than he does. It is much better to target those who can afford to pay so that the Health Service can be improved. Do we want a better Health Service? Of course we do. That is why I shall support the Government and vote for the charges.

Mr. Ian McCartney: For the past three hours I have been worried by the patronising, almost self-congratulatory and arrogant way in which the Secretary of State, the Minister of State and their supporters have dealt with the key principle of preventive medicine. The argument on principle is not confined to the proposed charges, and I welcome the fact that there is common agreement on both sides of the House that these charges foreshadow what the Government have set out in a secret manifesto that they will seek to implement during their present term of office or during the next one if, God help us, they win the next general election.
I shall deal with the issue in a way that is different from the one that has been followed by those who have preceded me. We have heard politicians arguing eloquently along the lines that are set out in prepared briefs. I shall advance an argument from the other side of the wall. I have had personal experience of the results that stem from the inability to receive preventive medicine in time to prevent blindness.
During the 1970s, when visited the House to see my father, who was then the hon. Member for Dumbarton, Central, I took ill. I was sent to Moorfields eye hospital, where it was found that I was suffering from Eels disease. For the following two years I was entirely blind in my left eye. I could see nothing apart from the light and colour that was visible through my right eye. Eels disease is especially nasty when it is contracted by men and women in middle age and pensionable age.
I was struck down with Eels disease in my mid-20s. Over two years I underwent 19 operations at Moorfields, some of which were of an extensive and complicated nature, using the latest laser techniques and other surgical procedures. I owe my sight to the "qualities" of the professors at that hospital and to the dedicated skill of those engaged in the prevention of eye disease and the restoration of the ability to see for those in my position —the magic of seeing again.
I received my sight back at some personal cost as a result of the social effects of my illness. There were also costs to the state and to my family. I had 19 complicated operations, the last three of which were of a type that Professor Hill had not tried before. Yet he carried them out in an attempt to restore my sight. Thousands of pounds were invested in that programme of operations by Professor Hill and the Moorfields eye hospital. I was not unique at the hospital. It was full of people suffering from permanent blindness, going blind or seeking treatment to restore sight as a result of the lack of preventive medicine in the community.
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I suffered social effects as a result of my illness. For two years I was unemployable. For six months I was unable to hold my three-year-old son because even the smallest shake could cause a haemorrhage in the eye. Such haemorrhages are part and parcel of Eels disease. Eels disease and invitreous haemorrhages are caused by infestation of the eye which causes substantial and serious blood clots, many of which are inoperable. For the middle aged and pensioners who are afflicted that usually means the end of sight and the removal of the eye or, in some cases where both eyes are affected, it could mean total blindness.
The effects of such illnesses are not restricted to loss of employment and the cost to the state and the family that


that involves. Those illnesses also cause social problems in the family. They bring pressure on a family as it must come to terms with the fact that one central, important member of the family must accept the possibility of total blindness. The family must accept that the person concerned may be unable to work and have a career. The family might suffer a loss of income. Those factors have social consequences for the family. My family was no different from many families which suffer from blindness. I live with those consequences today in terms of my former marriage as the family could not stick together because of the nature of the illness and the pressures that it brought on the family.
When the Minister talks about vested interests, it is important to know what we are talking about. My vested interest and that of hon. Members on both sides of the House lies in the belief in the prevention of disease and illness because of their social and financial costs to the state. The doctors and professors whom the Minister attacked so glibly a moment ago left at their own expense within hours of the Bhopal disaster to go to India to try to prevent mass blindness among the people of that stricken town. The professionals have a vested interest in their own position and in the well-being of their patients and the community in which the patients reside.
One of the major arguments in the debate is about communities and preventive medicine. I am a child of the National Health Service. I was born in a steel and coal community in 1951. I have early recollections of the workings of the service. I was among the first generation to be born under the NHS. I saw the effects of inoculation, eye tests and screening as part of eye tests. I remember as a child that 50, 60 or 70 of us at a time lined up to take the tests in a working-class community. Preventive medicine is important to the community as an attempt to prevent disease and to ensure that the community is properly served in terms of facilities for all people.
The Government talk about cost-effectiveness and in my short contribution so far I have talked about how my illness affected me and my family. The Government argue that cost-effectiveness is irrelevant. My illness has resulted in a net loss to the community, both in terms of the cost to Health Service in trying to put right the damage to my eyes and the cost to the Exchequer of social security and sickness payments. It makes no sense to impose such a small charge and put at risk so many individuals in the community.
If the Government are really looking for a trade-off for this small amount of money, why not trade off some of the tax cuts that so many hon. Members voted for only a few short months ago? What about a trade-off with the assisted places scheme for educational attainment, the money that has been pumped into city technology colleges at the expense of the rest of the education service, or even half the money from the wholesale sale of the royal ordnance factories at a third of their market value? If the Minister is really interested in a trade-off, trade off those items, not the health and sight of many thousands of potential victims in Britain.
I know that many hon. Members wish to speak and, like me, have waited a number of hours to participate. I hope that when the Minister replies in his histrionic way he will not return to the blackmail of today's Autumn Statement. The House should be supreme in the

decision-making of this country and it should not be subservient to anybody, whether it be the Chancellor of the Exchequer or the Prime Minister. If the House decides not to impose these charges, the Government have a duty to come back here and put into the nation's budget the resources to provide that service.
Unless that is the case we are well on the way to having an elective dictatorship. That is another fundamental argument. Tonight the Government have been arrogant enough to name hospitals in the constituencies of those hon. Members who have argued persuasively against the Government. No stone has been left unturned by the Secretary of State in trying to denigrate the profession, or individual hon. Members who have argued against the Government's principles.
That leads me to suggest that it is not simply one or two additional charges that are at stake but the concept of who pays for preventive medicine in Britain. Therefore, in voting against this we are voting not just against the charge but against the whole concept of the market philosophy of this stinking Secretary of State—[HON. MEMBERS: "Withdraw."]—who is prepared to put at risk the sight of so many people for a few pounds. Hon. Members might shout. They have never understood the blackness of blindness and what it does to the individual or his family. I would never wish it on anyone. I can only say that I can stand here because I have been lucky. The opportunities given me by Moorfields eye hospital and the skill of its professors, nurses and doctors have enabled me to have my sight back. The tragedy is that for thousands that will not be the case. The Government's proposals mean that for many more blindness will be a reality.

Dame Jill Knight: I can assure the House and my right hon. and hon. Friends that there are infinitely better and calmer arguments in favour of retaining the Lords amendment than we have heard in the last few moments. I had thought that the financial advantages to the Government and the NHS of regular health checks were obvious. One reason why some of us are so concerned is that we do not believe that the Government have their sums right on this matter. The earlier that disease can be diagnosed, the cheaper and easier it is to treat and the greater the likelihood that the treatment will cure.
Preventive medicine means having a health check which discovers a disease at an early stage and then having something done about it. Some of us find it strange that the Government say that they will not do this, but will instead spend the money on preventive medicine. We truly believe that eye tests come under the heading of preventive medicine. This is the fence at the top of the cliff rather than the ambulance at the bottom of it. Everyone knows that that is more sensible and infinitely cheaper.
Since the Health Service began there have been many necessary changes, and I am not bothered which party introduced them. The fact remains that charges have been imposed for prescriptions and for various appliances as time has gone by. I entirely agree with that. It seems right and sensible that an individual, having been given a free test and discovering that a requirement exists—whether it be for spectacles, bridge work or whatever—should pay something towards the cost if he can afford to do so.
This debate is a fight to keep tests free and thus encourage people to take them regularly. That principle has never wavered in 40 years of the National Health Service. Other aspects have changed but never that. Tests


have always been free, and as a result of that rule thousands of people have had their sight and even their lives saved.
The early signs of many serious diseases reveal themselves in eye tests. I shall not rehearse them all because right hon. and hon. Members are well aware of what those diseases are. Almost 1 million people per year are referred for hospital treatment by optometrists who have discovered something wrong during testing. I understand that that number was the subject of some ridicule by one of my right hon. Friends, who said that not all of the 1 million people referred annually by optometrists ultimately needed treatment. Nevertheless, every single one of them was referred because it was thought that they should have a blood test or be checked for heart disease. The accuracy of an optician's referral is substantially higher than that of the general practitioner.
Earlier today, my right hon. and learned Friend the Secretary of State commented on radio or television—and as I did not hear the broadcast myself, I ask him to correct me if I am wrong—that opticians do not test for glaucoma, or that the eye test does not include a test for that condition. I do not know whether that is correct, but I assure my right hon. and learned Friend and all other right hon. and hon. Members that any person seen by a trained optometrist who is judged to be in an at-risk category will be checked. A child being given an eye test will not be checked, but that is no reason to say that the contribution made by opticians is not important.
I turn to one of the Department's own publications, "Health Trends", which points out that 72·5 per cent. of all glaucoma referrals to hospitals are made by opticians, while 23·7 per cent. are by general practitioners. That surely illustrates the value of the opticians' contribution, and the fact that they have saved the sight of many of their patients.

Mr. Peter Thurnham: I refer my hon. Friend to a letter that appeared in The Times yesterday from two consultant surgeons at Moorfields Eye hospital, who in referring to glaucoma commented:
There is no evidence that early diagnosis necessarily halts the progress of the disease, which in any case only leads to visual disability in a small minority of cases.

Dame Jill Knight: My hon. Friend would have been wiser to read The Times today as well, because his point was answered in a letter to it. The two gentlemen who wrote the letter are, I understand, retired and no longer work in that hospital. It is possible to produce this quote and that quote; all that I can say is that the quote that I gave is from the DHSS itself. The figure is accurate and, I should have thought, one that the whole House could accept.
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I hope that the House agrees that regular health checks are a good thing and should be encouraged. The Government's case is that charges will not discourage. We heard earlier this evening that checks by dentists showed a drop when extra charges were brought in. Charges have never been made for eye tests, so how can we judge at this stage whether demand will go up or down? What is interesting, however, is that some ophthalmic opticians in the United Kingdom still have figures showing a dramatic increase in eye examinations when they became free in 1947. I know that that is not a complete answer, but if

many more people took advantage of the free eye test when it came in, surely it is reasonable to suppose that the reverse may well happen.
Charges for eye tests in Alberta, Canada—as the hon. Member for Livingston (Mr. Cook) mentioned—were brought in very recently. Incidentally, they were levelled only at those between the ages of 19 and 63: people of pensionable age were not charged. But the drop in demand of 30 or 40 per cent. was so worrying for the Government that they took only 11 months to reverse their decision. My hon. Friends and I ask the Government to listen to what we are saying, because they too may have to reverse their decision if the vote goes the wrong way this evening.
There is no doubt in my mind that there will be a drop in demand, and my view is shared by all the professional organisations—including the British Medical Association, which cannot be said to have a financial or fiscal interest. My right hon. and learned Friend says that most people can afford to pay something for a test, and that those who cannot afford it will not have to pay. It is true that under my right hon. Friend the Prime Minister, Britain is more prosperous than ever before, and many more people have money in their pockets. But the House must not fall into the trap of imagining that everyone outside this building finds it as easy as we inside it do to put his hands on £12 or £15—for I warn hon. Members that the price of an eye test will be somewhere between those sums.

Mr. Nicholas Bennett: Will my hon. Friend give way?

Dame Jill Knight: This is the last time.

Mr. Bennett: Surely if people are deterred by the £10 or £12 that my hon. Friend says will be charged they will be equally deterred from buying spectacles if they need them; but she is not advocating free spectacles.

Dame Jill Knight: I do not think that point worth answering. I am saying that the cost of a test for people outside the House will be difficult to meet. Besides, no one has yet pointed out tonight that spectacles will be much more expensive because the Government have been forced to put VAT on them for the first time. Not only will people have to pay for their eye tests, but they will have to pay much more for their glasses.
I am extremely concerned at everything that I have heard this evening about pensioners. It is simply not good enough to say that as a country we spend so much on beer, so much on tobacco and so much on gambling. Not everybody spends money on beer, gambling or tobacco. Many people write to me and come to see me in my surgery about some of the more recent changes, such as those to housing benefit, saying, "I do not gamble, I do not smoke and I do not drink, yet I am finding it a hard job to manage."
I am very troubled about pensioners. Of course my right hon. and learned Friend is quite right to say that not all pensioners are poor. But we should not disregard those who are poor because they are more at risk than anyone else. After pensionable age, eyes are more likely to become diseased, so pensioners are in real need of regular care. Undoubtedly some early diagnoses will be missed, and it will be more expensive. Furthermore, members of the public are well aware that they are entitled to free eye tests in hospitals and many will go there. Like the dentist mentioned by my hon. Friend the Member for Great Yarmouth (Mr. Carttiss), many doctors know when their


patients are hard up and some will refer them to hospitals. The silly thing is that it costs the Government nearly three times as much to have an eye test done in the ophthalmic department of an eye hospital than they currently pay to an optometrist in the high street. It costs about £28 outside London and £30 in London, whereas they are paying the opticians £10. Where is the economic sense in that?
My right hon. and learned Friend and some other hon. Members think that optometrists will provide tests free. That is absolutely ludicrous. Why should they do that? Those men and women are professionals who have studied and trained for four or five years. It is like telling a doctor, "You can give your professional services free. Nobody will pay you for your professional services and you can make your money from bandages." That is ridiculous. Why should professional men and women who have studied and worked in their profession be expected to provide their services free?
Furthermore, the Government have already taken steps to ensure that when a patient has had the refraction, he must be given a prescription so that he or she can buy glasses elsewhere. The patient is free to go to the boutique down the road. An optometrist will not be able to say to a patient, "I have tested your eyes. You will buy your glasses here, won't you?" I have a letter from the Parliamentary Under-Secretary of State saying:
Opticians will be prohibited from offering sight tests on condition that any spectacles required are purchased from their business.
The Minister has already knocked one leg off the optician by saying that he can do a refraction and the patient can walk out, so he has done the test free. How can the optician keep his doors open? Furthermore, 25 per cent. to 30 per cent. of people who have an eye test are found not to need glasses. So there are two groups of people who walk out of the opticians, and the optician is paid not a penny. How will he pay his rent, his rates and his receptionist? It is an extraordinary argument.
Finally, is it fair that people who need glasses should subsidise those who do not need glasses? That is what will happen. If the optician is expected to provide free eye tests, he will have to put more money on the glasses that he is able to supply. That does not seem to be fair.
I know that the Government did not wish to put VAT on spectacles but it will greatly increase the cost. Why cannot the money brought in from VAT be used to keep the test free? Tonight we are talking about the breach of a principle that we have held to since the very beginning of the National Health Service. For the first time we are breaching a rule that was introduced for a very good reason.
It appears that the Government have already agreed that ready made spectacles should be available without a prescription. If ever I heard of a way in which to ensure that people do not get their eyes tested, that is it. People will have to pay quite a lot for the eyesight test and more for their glasses, so they may decide to get a ready made pair from Woolworth's.

Madam Deputy Speaker (Miss Betty Boothroyd): Order. The hon. Lady is coming to a conclusion, but it is extremely rude of hon. Members to have loud conversations during her speech.

Dame Jill Knight: I am indeed finishing. I am worried by that final deterrent to getting a test. The free test is important to the Health Service, important to the economy and important to health. I shall go into the Lobby in support of that principle.

Mr. Loyden: The House may have had some sympathy for the Secretary of State at the beginning of the debate as he had to argue an indefensible case, but he did not tell us what merit the Government's proposals have. He has dealt with the issue in a cavalier fashion. When hon. Members have illustrated the dangers of doing away with an important facet of preventive medicine, he has used an argument based on the financing of the NHS.
Like my hon. Friend the Member for Makerfield (Mr. McCartney), I have an interest in glaucoma although, unlike him, I did not know that I had an eye disease. I went for an eye test and was referred by the optometrist to the local eye hospital where glaucoma was diagnosed. I did not know what it was. The same probably goes for about 80 per cent. of the population. I had to go home and read the dictionary. It was rather old and said that glaucoma is a disease of the eye which can result in bursting and total blindness.
Thanks to advances in that segment of the Health Service, that is no longer the case, but early detection is essential if the disease is to be arrested. I sometimes think that the Secretary of State does not understand what it all means. If he does, he is acting in the worst tradition of a Secretary of State responsible for the Health Service. Having listened to the debate, any Secretary of State could not but be persuaded to change his mind.
The argument in favour of the free test has been won tonight. Conservative Members who have listened cannot fail to oppose the Government's proposal. The Secretary of State ought also to bear in mind the fact that people who cannot find the £10 or so that is to be charged are likely to go to eye hospitals such as the one I attend fairly regularly. If the right hon. and learned Gentleman goes to those hospitals, he will realise that cuts in the NHS have meant that people in St. Paul's eye hospital in Liverpool spend between three and five hours in waiting rooms waiting for attention, diagnosis and treatment. If people are deprived of eye tests by opticians, those waiting times will increase as general practitioners refer their patients to hospitals if disease is suspected. This will add to, rather than reduce, the costs of the NHS.
12 midnight
The Secretary of State presented a facile argument to the House. He is doing a disservice to the Health Service by denying people the right to access to a part of preventive medicine. I said earlier that I was dissatisfied with the rate at which the Health Service was moving towards prevention. The Under-Secretary, who allegedly supports preventive medicine, should vote against these measures.
All the aspects which are considered to be an advantage of the Health Service and a part of preventive medicine contribute greatly to people's well-being and health. No Secretary of State has the right to increase the risk of undetected glaucoma and other diseases as this Secretary of State is doing. He is increasing the possibility that a person will end up in hospital for a major operation when


his condition could have been detected early and that he will be required to attend the hospital once every six or nine months for treatment.
This is damning evidence of the way in which the Government have treated the National Health Service and further evidence of their aim to change or dismantle it. Every charge that is made is a further erosion of the NHS. Every charge for screening, which is part of preventive medicine, erodes the nature and value of the Health Service and the benefits that have accrued from it. The whole House should reject the flimsy arguments put for the proposals. The Secretary of State has not made out a case on medical grounds. He has referred constantly to market forces. He talks about people going for eye tests merely because they require spectacles. Surely that is the whole point. Of course, they go for spectacles, and then they find out that something is wrong. They are referred to a hospital and treatment takes place. By his decision, the Secretary of State will deprive people of access to a part of preventive medicine. We should condemn him outright for that.
A further chance is being given to Conservative Members. The Opposition cannot defeat the Government and carry the amendments, but Conservative Members should go into the Division Lobby and do exactly that.

Mr. David Shaw: I support the Government on the issue of introducing charges for those who can afford to pay. My reasoning is similar to that which led the Conservative Opposition to support the Labour Government in 1951, when Labour first imposed charges on spectacles and dentures. Labour's Health Minister gave four criteria for introducing charges. The first criterion was that more money should be made available to the NHS. That is exactly the argument which we put forward—there should be more money for use within the Health Service. In 1951, the Labour Government were worried about whether the elderly were getting proper treatment under the Health Service. The Labour Government were concerned about hospital services and waiting lists and whether the hospitals were getting enough money. That is precisely what this proposal is about. It was as true then as it is now.
The Labour Minister went on to say that the charges were useful because they could be imposed in such a way that they would have virtually no effect on seriously ill people. That is also true today. The charges were not costly to collect—then or now. The Labour Minister also said that the charges were useful for deterring abuse, not that there was much abuse of the tests. The same applies today.
I have one reason for saying that the charges are sensible that did not occur to the Minister in 1951: fairness. About 21 million people will be exempt from these charges, which could not be said of the Labour proposals in 1951, or of any subsequent Labour proposals.
The proposals are reasonable because only those who can afford to pay will have to. It is interesting to read in Hansard what Labour Members said in 1951. Nye Bevan described the charges as a mutilation of the NHS. Many other Labour Members suggested that the charges were the end of the Health Service. The Labour Health Minister suggested that the debate was getting out of proportion. It has not changed much since then. Meanwhile, the NHS has gone from strength to strength, the forebodings of Nye

Bevan and the warnings of many other Labour Members notwithstanding. It has done so especially under Conservative Governments such as this one.
It is worth noting that almost all the Labour Members who spoke against the charges in the House in 1951 voted for them in the Lobby afterwards.

Mr. Joseph Ashton: They are all dead now.

Mr. Shaw: I see the right hon. Member for Blaenau Gwent (Mr. Foot) behind the hon. Member for Bassetlaw (Mr. Ashton). He is not dead, and I trust that he will vote with the Government tonight, as he did in 1951 when they imposed charges.

Mr. Elliot Morley: What charges for testing for the identification of the early stages of diseases have any Labour Government brought in?

Mr. Shaw: The principle of charging is exactly the same now as in 1951, when the Labour Government introduced charges. Hugh Gaitskell introduced them on the four criteria I outlined earlier, and on the basis that they represented better use of NHS money. That is the key. The eyesight test does not, in itself, improve people's sight. Taking action, having treatment and wearing glasses do that. Government action to increase the use of spectacles has done far more for improving people's eyesight than anything else.
In 1984 the Labour party fought like mad against the introduction of privatisation and competition in providing spectacles and eyesight testing. Now, more spectacles are sold than before, more people go for tests, and the public are more aware of the efficiency of the private sector. That is why I believe, with my right hon. and learned Friend, that the private sector would absorb the charges over time. It will want to expand to its business. It is in its interests to attract more people for testing.
This measure, given the concessions made by the Government for glaucoma and diabetes sufferers, is fair and correct. The Labour party is dishonest about imposing charges. Many of the founder supporters of the NHS supported the Government who brought in charges in 1951. We now have a better service, whose costs people appreciate better. Many of the fears expressed in 1951 and 1984 have proved unfounded. I have no hesitation in supporting the Government; the Lords amendment should be rejected.

Mr. Fearn: Much of what I said in the earlier debate applies to the introduction of charges for eye tests. I repeat what I said last December: the proposed charges for eye tests make a mockery of the Government's announced intention to improve preventive health care.
The original 1986 Green Paper, page 32 item 4, states:
Free NHS sight tests and prescriptions are maintained for everyone who needs them. The sight-test can identify health problems as well as a need for spectacles, so it is important that skilled sight-testing should remain readily available.
I want to know what the Government consider to be "readily available". A charge of £10 will make it virtually impossible for many parents, young people in their first jobs and those in part-time or low-paid employment, many of them elderly, to avail themselves of any sight test. Once again, the Government appear to be acting against the recommendations of all the professional groups and voluntary organisations with experience in this area, all of which claim that the introduction of a charge for the eye


test would negate the aim of the promotion of better health. Patients will be deterred, and eye diseases and other conditions will go undetected.
The financial savings that the Government expect to make have also been challenged. It is expected that more patients will visit their general practitioners who, in turn, will have to refer them to eye hospitals. There is the added cost of the treatment of disease and conditions which, if detected, could be remedied at less expense.
We are not simply discussing finance. It is a question of people's lives and the quality of those lives. Are hon. Members willing to introduce proposals that may lead to unnecessary discomfort, poor vision and, in some cases, loss of sight? Are we content that people who may already be hampered by the disabilities that come with age—and that will eventually affect us all—will be put under further stress because they cannot afford £10 or more for a sight test? Are we willing to introduce a measure that may prevent people with diabetes, blood pressure and other conditions from obtaining an early diagnosis and treatment? If this House is interested in prevention as part of the health care of the nation, it will support the Lords amendment and encourage opticians to give more extensive eye examinations and the population to have more regular checks. That could be as effective as other screening programmes.
There have been suggestions that competition in the sight test market will reduce the cost or even eliminate it. I very much doubt that, as most consumers know that nothing comes free these days. Any freebies such as free estimates are always absorbed into the cost of the product, making it more expensive.
On 20 October the Prime Minister, as reported in the "Parliamentary Health Monitor" of 31 October, said that she thought it reasonable for people to pay a modest charge for something fundamental to their health. I am pleased that she recognises that such tests are important to an individual's health, but I question her assessment of a modest charge. It may be modest to someone like the right hon. Lady who enjoys certain comforts, but £10 is not a modest amount to the many people who have far lower incomes.
I remind the Prime Minister and the Secretary of State that the British people already pay charges for their health care through the system of general taxation—not just income tax, but VAT and other taxes. That means that virtually everybody contributes to his or her health care and, as opinion polls show, would be willing to contribute more through that method.
I hope that many Conservative Members will recognise that the introduction of charges will be harmful to prevention and promotion in health care and to the long-term effectiveness of the system. I hope that they will vote with Opposition Members in support of the Lords amendment. In doing so, they will also be sending a message to thousands of their supporters saying that they really care. That, I doubt.

Mr. Hayes: I wish at the outset to deal with the rather unpleasant rumour that an altercation occurred earlier between my hon. and learned Friend the Minister of State and myself. What my hon. and learned Friend said was

said in the heat of debate and, I understand—because I have known him as a friend for the last five years—was said in fun. I did not take it personally, nor did he, and I hope the matter can rest there. I sincerely hope that there is no wicked press circulation of any rumour about bad blood between us because I assure the House that there is none.
I shall be brief because many of my hon. Friends wish to speak. A peculiarity of tonight's discussion is that we have been dealing with the subject of preventive medicine. While the Bill may be concerned with preventive medicine, the provisions that we have been debating tonight have nothing to do with that. They have everything to do with money.
A year or so ago my right hon. and learned Friend's predecessor was rolled over by the Chief Secretary to the Treasury who, as we know, is an able and talented Minister with a wonderful way of dealing with ferocious Cabinet Ministers. He invites them into his office and for some reason they roll on the floor and let him tickle their tummies while he takes their wallets. The trouble is that those Cabinet Ministers then expect us to bail them out, and we cannot do that.
The Secretary of State has not been a soft touch. He came to the House today with a very good health package indeed, and all credit to him. But to talk of £140 million as a major sum is utterly ridiculous. It is probably equal to the Foreign Office lunch bill. And as for the £27 million which would exempt the 6·5 million pensioners in question, that is probably equal to the Deputy Leader of the Opposition's lunch bill.
I remind hon. Members that it is easy to score party political points. While we have been talking about those who can afford to pay, according to the Royal National Institute for the Blind, 78 per cent. of the population between 78 and 85 years of age have major eye disease, yet 50 per cent. of pensioners still live on or just above the poverty level. The top 20 per cent. of retired households with more than twice as much income as the 80 per cent. below them pull up the national average, and for far too many pensioners who do not qualify for a sight test any charge will act as a significant deterrent.
My right hon. and learned Friend is saying, in effect, "I will take a risk. I do not know how much it will cost ordinary people and pensioners. It could be £10, £15 or absolutely nothing. We will leave it to market forces." But 70 per cent. of optometrists' incomes come from sight tests. From where will the other 30 per cent. come? Clearly, it will be loaded on to the price of spectacles and contact lenses.
About 6·5 million pensioners are particularly at risk. It is absolute nonsense to pooh-pooh the idea that going to the optician is not total screening, and that has disturbed me in relation to some ministerial statements made this evening. Optometrists can diagnose diabetes, glaucoma and cataracts—diseases that are particularly prevalent among those over the age of 60. People over the age of 60 need to have their eyesight tested regularly. In future the poor devils will not know that they have diabetes or glaucoma or cataracts until it is too late.
We should be trying to encourage people to visit their optometrist, optician and dentist. If a charge of f 10 or £15 is slapped on to the sight test, as I believe will happen, those pensioners just above income support—whom Ministers tell us will not get any support from the state—will have to make a choice between paying their gas or


electricity bills—[HoN. MEMBERS: "Don't be silly."] Sadly, some of my hon. Friends are telling me not to be silly. It will be interesting to see how many letters they get from their constituents when it gets colder—perhaps from the same constituents who have been clobbered by the housing benefit changes over the past few months. Some pensioners will have to choose between paying their fuel bills and going to the optometrist to have diagnosed any diseases from which they may be suffering.
This evening we could prevent much pain and suffering, and a great deal of money could be saved for the National Health Service in the long term.

Mr. Nicholas Bennett: I have listened carefully to the debate since 5.30 this afternoon. It has become clear that this is a debate about priorities and about deterrence. My hon. Friend the Member for Harlow (Mr. Hayes) is wrong to describe the sum of £ 140 million as trivial. It would pay the total costs of my local health authority six times over, and it would buy two completely new district general hospitals. We must ask ourselves whether we are right to regard expenditure on eye tests for those who can afford them as a priority or whether it would be better to divert that money to other aspects of the Health Service.
The problem goes right back to the beginning of the Health Service in 1948. The other day, I was looking at the minutes of the Labour Cabinet of 13 December 1948. Aneurin Bevan, after only five months—[Interruption.] Hon. Members may not be interested in priorities, but Aneurin Bevan said that Socialism was about the language of priorities. The Labour Cabinet found that in only five months of running the NHS the total cost had risen 30 per cent. above the estimates of July of that year. We have to make difficult decisions about where money should be spent in the Health Service, and I do not believe that it is unreasonable to ask those who can afford it to make a modest contribution towards the cost of their health.
If there is no competition between opticians and if the cost is not subsumed in other charges and through opticians maximising their custom, the charge will still be no more than the equivalent of the cost of five or six pints of beer in the more expensive public houses. It will be equivalent to twice the average weekly spending on tobacco in this country, half the price of a tank of petrol and about three Chinese take-away meals. That is to put the charge in the context of those who can afford it.
We are told that 62 per cent. of people are to pay the charge and 38 per cent. are to be exempt. Sixty-two per cent. is exactly the percentage of the population who own their own homes and it is smaller than the percentage of people who own telephones or cars. Are we really saying that people can afford to own their own homes, cars and telephones, yet that they cannot afford to pay a £10 charge for an eye test? I do not believe that that is a reasonable view to take of how people spend their money.
The argument about deterrence is an arrogant one because it says that working people are so stupid that they are not prepared to spend a small amount of money on looking after their health. I do not believe that that is true. There is no evidence that the increase in prescription charges during the past 10 years has deterred people from taking care of their health. It is a small and useful measure to send money to where it is needed and to ensure that people have a right to make a small contribution towards their health. I support the Government.

Mr. David Blunkett: I did not intend to address the House on this issue until the hon. Member for Pembroke (Mr. Bennett) had the audacity to talk about three Chinese take-away meals in the same breath as talking about preventing people losing their sight by having an adequate eye test. I believe that that is deplorable. There are many arguments about whether people would pay to have a test to ensure that they were certain that they would receive adequate medical attention for a problem that they had experienced. We shall not further debate in the House by lowering it to the question whether people will buy consumer goods as opposed to having their eyes tested.
Many people who are worried about a problem—whether it is something that has occurred in old age or something that has come over them while they are young —face the trauma of deciding whether to consult their GP or to have their eyes tested because they are uncertain whether it is a serious matter or a passing phase. As many people have said over the past few weeks, if money can be saved by ensuring that a problem is picked up during its early stages by giving people the opportunity of having their eyes tested easily and cheaply and either being reassured or having action taken at a stage when long term problems can be prevented, no one in the House or in this country should deny that person the right to a free eye test. It does matter what happens to other people around us. We have obligations and responsibilities to help each other —not just those who are deserving and responsible because they do not spend their money on three Chinese meals. What happens to the person living next door and to the person sitting next to us tonight is the responsibility of all of us. If by spending a small amount of money we can prevent the deterioration of a person's sight and money being spent on putting right long-term problems, every hon. Member, whatever his politics or ideology, has an obligation to vote to defeat these charges.

Mr. Maxwell-Hyslop: We can sum up the debate by asking two questions. Do we wish to encourage people to have their eyes tested or to discourage them? I think that the question answers itself: we want to encourage them. The evidence for that has not been challenged. Secondly, do we want to lengthen the waiting list for out-patient clinics at ophthalmic hospitals or at the ophthalmic departments of general hospitals, or do we not? The answer to that is clearly and obviously no. On both those bases, therefore, we should vote to sustain their Lordships' amendment.

Mr. Thurnham: I speak in support of my right hon. and learned Friend the Secretary of State because we know for a fact that this measure will raise £80 million for the National Health Service and we have to weigh that in the balance with the theory that the charge will be a deterrent. I do not believe that it will be a deterrent, but there is no way that we can prove that. I do not believe that there is such a thing as a "free" test because the tests have to be paid for and the cost recovered in one way or another.
Those who argue that charges are a deterrent in one sense must also accept that they are deterrents in another sense because if the money is not raised from the people who benefit from the test, it will have to be raised from the taxpayer. There is then a deterrent for those who have to


earn the income with which to pay the taxes. We know what happens when the Labour party is in power—we have taxes—

Mr. Christopher Hawkins: If my hon. Friend really believes his argument, should we not charge people to go to a general practitioner, or charge for cervical smear tests and for breast screening on the ground that that would raise money for the Health Service?

Mr. Thurnham: My point is that if we have taxes at the level that the Labour party had when it was in power, we know exactly what happens to the economy. The Labour party was the party that had to cut hospital building. The Conservative party is the party that raises the funds to build the hospitals. In 1977 the International Monetary Fund had to bail the country out. That was when hospitals faced cuts.
It is for those reasons that I support this measure, which will raise more money to enable the hospitals that we need to be built. I have weighed that in the balance with the theory that charges might be a deterrent. I believe that those people who feel that they want a test will go to have that test and they will pay for it because they are benefiting from it. They will pay for it either directly or through charges for their spectacles, if they need them. If anybody is deterred from seeking a test, I imagine that it will be the 25 per cent. who currently go only to find that they do not need spectacles. It is for that reason that I support my right hon. and learned Friend in raising funds by this measure which can do nothing but improve the National Health Service for the public.

Mr. John Hunt: I have found tonight's debate a profoundly depressing parliamentary occasion. I am bound to say that I regard the proposal to charge for sight testing, at whatever level that charge is eventually set, as mean and misguided. In spite of the confidence and conviction of my right hon. and learned Friend the Secretary of State that charges will not be a deterrent, I believe that they will serve as a deterrent to those most at risk.
I am sure that it will not have escaped the attention of my right hon. and learned Friend that the opposition to these proposals from this side of the House spans the spectrum of our party. Wets and drys are for once united in a common cause and are speaking with one voice in defence of preventive medicine. That is a point of considerable significance. I am surprised and sorry that, faced with this expression of deep and genuine concern among a wide range of the members of our party, Ministers have shown such a reluctance to respond to those genuine concerns.
I advise my right hon. Friends on the Front Bench that charging for eye tests is destined to do maximum political and social damage with minimum benefit, either to the coffers of the Treasury or to the reputation of our Ministers and our Government.
I know that some of my hon. Friends are especially concerned with the impact of the charges on the lower paid. I would certainly not dismiss that concern, but my special and specific concern tonight is with pensioners and with the impact of the charges upon them. We know—we have been told—that to exempt that category will cost £27

million per year. However, I have already told my right hon. and learned Friend that in terms of the Treasury's book-keeping, that is petty cash.
Of course, we all welcome the additional funds for the National Health Service announced by my right hon. Friend the Chancellor this afternoon, but surely that begs the question. If we can find an extra £2 billion for the National Health Service and if we can make massive debt repayments, surely we can find the £27 million that is necessary to exempt the pensioners from this charge? That is the answer to the argument by my hon. Friend the Member for Pembroke (Mr. Bennett) about priorities.
However, it appears that, for the sake of a minimal saving in public expenditure, we are prepared to put at risk the sight of the elderly. This is not crying wolf. Let us make no mistake about it. The elderly are particularly vulnerable and are likely to suffer from the diseases about which we have heard—glaucoma, cataracts and hypertension, all of which can be detected at an early stage by regular sight tests. My hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) has reminded us that almost one million people a year are referred for further medical investigation following an eye test. I understand that more than half of those are over 60. That shows the potential danger of introducing this charge.
We are told that a charge of £10 or £15 will not deter and that the Government object in principle to across-the-board benefits. I can say in answer only that, from my experience, the more wealthy pensioners seek private treatment anyway, but anyone who has regular contact with the elderly knows that, even if they are well off, they fear for the future. They watch every penny and avoid spending money whenever they can. My worry is that, faced with a charge of £10 or more for an eye test, they will keep putting it off. They will make do with their glasses and, in the process, often serious and irreparable damage will be done to their sight.
That is why, even at this late stage, I beg Ministers to think again about this policy. Unless they do, there is no way that I can go into the Lobby with them tonight.

Mr. Robert G. Hughes: Earlier this evening, the hon. Member for Makerfield (Mr. McCartney) told us of his experience when, in his twenties, he lost his sight. Like every other hon. Member, I listened carefully to what he said, but if I believed that, because of these proposals, the care that he received at Moorfields eye hospital would be withdrawn and the condition that he brought to our attention would not have been brought to anyone's notice, I would not vote for the proposal. However, I do not believe that that is the case. I hope that the hon. Gentleman will accept that, although what he said to the House was harrowing, personal and important, it is not relevant to tonight's debate.

Mr. Flannery: The hon. Gentleman, with the best of motives, has completely misjudged the issue. My hon. Friend the Member for Makerfield (Mr. McCartney) was talking about a different matter. We are discussing those people who go to an optician, perhaps for spectacles, and discover that they have glaucoma. My hon. Friend was talking about something peculiar to himself and he obtained the necessary treatment.

Mr. Hughes: I shall make clear later my views about that matter. The hon. Gentleman makes an important point and I shall not duck the issue. If he is not satisfied, he can deal with the matter in his speech.
I want to refer to the Health and Social Security Act 1984. My right hon. and learned Friend the Secretary of State has quoted what Opposition spokesmen said at that time. There can be no doubt that the arguments advanced by the Labour party were fundamentally flawed. Opposition Members said that, as a result of the measure, people would go blind and the price of glasses would increase. [Interruption.] If Opposition Members do not believe me, they should read the relevant debates. The hon. Member for Holborn and St. Pancras (Mr. Dobson) said that, as a result of the measure, many people's eyesight would suffer and that the Government's proposals would reduce choice, abandon consumer protection and put up the price of glasses. Nothing could be further from the truth. We know that prices have been reduced in the high streets while consumer choice has increased.
The Labour party was not alone in getting it wrong in 1984. The arguments that were advanced by opticians and the ophthalmic trade at that time and those that they are advancing now are almost identical. They were wrong in 1984, and in my judgment they are wrong now. In 1983, Mr. John Thorpe, on behalf of the Society of Opticians, said:
Spectacles may be cheaper, except for those who cannot see.
That argument was wrong then and I submit that it is wrong now.
Only two years after the 1984 legislation was enacted, glasses sales increased by 10 per cent. During the same period the number of eye tests increased by over 1 million. The nub of the argument—I take up the point which the hon. Member for Sheffield, Hillsborough (Mr. Flannery) made in his intervention—is whether people will be able to pay the proposed charge, but it is my judgment that the charge will not be levied. The 1984 Act, which revolutionised the industry, has done much to bring greater consumer choice and reduced prices. It has led to many major companies slogging it out in the market place to make sure that they get their share of the market. Those who benefit from their struggle are those who need spectacles. Companies will not want to relinquish their market share and I believe that they will offer free eye tests.
We are talking of a profession that guards its standards carefully, which means that it will offer proper eyesight tests. Anyone who suggests otherwise is insulting the opticians' profession. I believe that the Lords amendment will be rejected and that the proposals of my right hon. and learned Friend the Secretary of State will lead to wider availability of eyesight tests. The Bill will act as an incentive for the public to get their eyes tested, not as a disincentive. [Laughter.] The predictable laughter of Opposition Members is the same ill-informed laughter, with the same ill-informed comments, that we heard from them during our consideration of the 1984 measure. They did not understand the market then. They did not understand what consumers wanted or what was happening. It is clear that they still do not understand the market. If Labour Members want to speak, let them make their own contributions to the debate.
I support my right hon. and learned Friend the Secretary of State. When we reflect on this measure, we shall understand that he was right. His judgment is good and it will lead to opticians providing a better service.

Mr. Michael Irvine: The hon. Member for Livingston (Mr. Cook), as he sometimes does, let his guard drop for a moment when he dismissively referred to the £70 million that the proposed charges will save as a "modest sum". That is the kind of cavalier attitude to public expenditure savings which in the long term does real damage to the National Health Service.
Over the years the NHS has suffered considerable capital investment damage through financial indiscipline and a cavalier attitude to public expenditure savings. The fact that the charges will save £70 million is not to be scoffed at. That money will be ploughed back into primary health care and will provide £70 million of extra resources for the NHS.
The hon. Member for Livingston should be aware that the merit of the charges does not stop there. If we provide services for free, be they medical or optical, there will be waste of public resources which could be better used elsewhere.
12.45 am
At that point the debate links up to the very serious matter of whether people who need eye tests will be deterred from taking them because of lack of means. The 36 per cent. who will be exempted are all right, but it is wrong to look at the remaining 64 per cent. simply as a group of affluent people. That is not the case. Certainly many of them are affluent and can well afford to meet the fees. They should certainly meet the fees. However, I acknowledge that there is a not insignificant number of people who are just above the exemption limit for whom there is a risk that the charges will prove a deterrent.
The competitive effect of the charges will come into force here. They will have such an effect because they will introduce market forces into an area where those forces are needed. To date the optical profession has had things too easy. It has had a captive amount of money from the Government for some time. It will now have to compete in the market place. As sure as night follows day it will drop its prices. Some within the profession will offer free optical tests. I confidently forecast that the Government will save £70 million and there will also be the widespread availability of free optical tests. Market forces will come to bear and the charges will have a beneficial effect.
I ask my hon. Friends who are teetering on the brink of rebellion and are not quite sure whether to go over the edge to consider those factors carefully. My hon. Friend the Member for Staffordshire, South (Mr. Cormack), who is in that position, wants to make things clearer.

Mr. Patrick Cormack: Does my hon. Friend think that some of the opticians will give free washing machines—[Interruption.]

Mr. Irvine: I would not extrapolate the argument quite that far, but my hon. Friend has got the general thrust. On that happy note, I conclude my remarks.

Mr. Mellor: I trust that the mood of euphoria that my hon. Friend the Member for Ipswich (Mr. Irvine) has so successfully created may be continued for the remaining minutes of the debate.
I begin by thanking my hon. Friend the Member for Harlow (Mr. Hayes) for the friendly comments that he incorporated in his speech. I entirely reciprocate them and for my part I am sorry if the badinage between us appeared a little more serious than it habitually is in the conversations that we have had together over the years.
The House should focus on a further example of increased provision within the Health Service when considering the background to the issue; one in which a considerable amount of progress has been made in treating fundamental and difficult eye disorders that arise within our society. Take, for instance, the distressing problem of cataracts. In 1976 there were 40,000 cataract operations. I am not making a party point. I am talking about the development of the service. By 1985 there were 59,000 cataract operations. Our target is to take that up to 70,000 by 1990 and I am confident that that will be achieved.
It is not just a question of ensuring that the treatment is available to deal with these difficult conditions. It is also important that we increase people's awareness of the significance of their eyes and the importance of not taking their eyes for granted, even when it appears that there is no reason to consider that they are in difficulties.
That is why, once again, the resources that the Government are making available, above and beyond what was made available by any of their predecessors, are aimed at trying to encourage eye awareness by proper promotional campaigns and to ensure that there is a proper supply of professional people at all levels of the service able and willing to deal with the rectification of these problems.
That is the way forward, the way in which we can ensure that the maximum number of avoidable eye conditions are detected early. That is the way we shall ensure that the community genuinely sees the necessity of having regular checks. Once again we are in exactly the same situation that we were in with dental charges. While a lot of people do go, even more do not, and it is overall eye awareness that needs to be raised.
Essentially, the argument comes down to this. The Government believe that against a background of over 20 million exemptions and the fact that most people will require an eye test only every two years—the recommended period—while many people leave it perfectly safely for three years, a £10 charge is not a burden in an increasingly prosperous society.

Mr. Gary Waller: My hon. and learned Friend referred to deterrence and the debate hangs to a considerable extent on whether people will be deterred from having eyesight tests. Will his Department have access to information about the number of eye tests being carried out, and, if it is discovered after a reasonable period that people are being deterred by any action taken by the House tonight, will the matter be looked at again?

Mr. Mellor: I appreciate that a number of people, like my hon. Friend, are worried about the matter. Yes, statistics will continue to be kept of NHS eye tests—those that continue for the exempt 20 million. We shall, by samples and other scientific ways, find out whether the number of eye tests in the rest of the community is growing on the same basis that it has been growing in recent years.
Of course, all this turns on the assessment that sensible people make of the evidence. Plainly, in such issues it is perfectly reasonable for one group of people to arrive at one conclusion and for others to arrive at another. I shall later say why I believe that what we have decided is based on a proper inference drawn from previous occasions when, for instance, we deregulated the optical industry.
Clearly, we shall want to monitor the consequences of the change. Of course we recognise the need to reconsider any aspects of these arrangements should the evidence require it. I hope that my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) and other right hon. and hon. Members who are concerned about this aspect will accept that that is said in good faith and that it will be carried through by the Government.
The opportunities offered to the profession will give opticians the prospect of building on the skill and experience of optometrists in offering the kind of service that the community needs, so encouraging people to make more use of their services. I quote from an article by Marvyn Slater, a Fellow of the British College of Optometrists, published in The Daily Telegraph on 18 October:
With the prospect of a revitalised private service on the horizon optometrists can stop relying upon spectacle sales and offer their unique skills—the management of healthy eye disorders, visual ergonomics, visual and neurologically related educational disorders, industrial consultancy, low vision aids and assessment—to the 50 per cent. of the population who will be ineligible for NHS sight tests.
I feel sure that he is pointing the way to an altogether more satisfactory future for optometrists than having them remain imprisoned within the framework that the present NHS imposes upon them. It will give them a chance to break out and to make their presence felt.
Why are the Government so confident that this measure can proceed, liberate resources to go elsewhere in the Health Service, and not cause difficulties in a prosperous society? It is because we have been here before. We have been through the battle in respect of the deregulation of opticians and the various dire predictions that were made then. I shall not quote them now, but suffice it to say that concern was expressed not only from the Opposition Benches but by my right hon. and hon. Friends as well.
My hon. Friend the Member for Edgbaston will recall the speeches that she made on the subject, when she expressed great fear about the consequences of that development. I say to my hon. Friend that I hope that she and others will take comfort from what has happened. It has shown that the predictions were not accurate and that the Government have been able to create an altogether better market and an altogether more satisfactory service than before. [HON. MEMBERS: "Oh!"] I detect a degree of scepticism among one or two of my hon. Friends and so I shall give them the facts upon which I rely for that observation.
First, although three quarters of the people who go for tests already wear spectacles and so know that they will have to pay, the number of tests is up by 1 million over that period. Secondly, sales of spectacles have increased by 10 per cent. which is a sign of the market's increased buoyancy. Thirdly, there have been considerable benefits from price reductions of a most marked kind, which have been in the consumer's interest, and wider choice.
The figures are very striking. The average cost of private spectacles in 1981 was £59·26. In 1986, five years on, it was £57·88. In other words, there was a reduction in


the average price of spectacles over those five years. Put another way, the average cost for NHS and private spectacles taken together fell from £44 in 1981 to £31 in 1985; a 28 per cent. drop in real terms. It is on that basis that we make the predictions we do about the consequences of this latest change.
Testing for glaucoma clearly concerns many people. My hon. Friend the Member for Edgbaston said that, whenever a person of the appropriate age was eye tested, a glaucoma test is also made. I do not want to take issue with that. I believe that there is concern about whether a test under the new system—a "deregulated" or "privatised" test—will include the test for glaucoma. We have powers under the Bill to make requirements about what the tests should comprise. I take very seriously the points made about glaucoma, and we shall want to discuss them with the professions and other interested parties to ensure the right result.
1 am
The debate is about how far in a mature and prosperous society people are prepared to pay modest charges for a service that most recognise will involve extra costs as soon as they embark on it. The difficulty in which my right hon. and learned Friend and his Ministers find themselves is that, even against a background of the most generous settlements that there have been for increased funding of the NHS, a range of competing priorities and demands must still be met: expensive high-technology medicine, the increasing requirements of an aging population and the need for enhanced psychogeriatric care.
I assure the House that, although my right hon. Friend the Chancellor has generously made the money available, it took a great deal of persuasion, as my right hon. and learned Friend said earlier. The case had to be made that the money would be properly targeted on improved patient services and not swallowed up in inefficiency and bureaucracy, or used for purposes that no longer required a heavy public subsidy. If we are unable to make these savings, surely some other choice will have to be made, and it is difficult to know how easy the decision will be. I ask my colleagues who oppose us at present to think very carefully about that aspect.
I also appreciate how difficult the issue is seen to be by many of my hon. Friends on the Back Benches. The appointment of my right hon. and learned Friend to the Department of Health was greeted very warmly by my colleagues. With his Ministers he has had the opportunity to look carefully at policy proposals for the future, and to consider what we shall have to pay to make the NHS work efficiently and to try to clear up the many problems such as excessively long waiting lists and inconsistencies in key performances between one district and another.
I hope very much that before casting their vote against my right hon. and learned Friend my hon. Friends will give thought to his categorical judgment that we can safely make the decision we are making, and that any alternative will cause grave difficulties to the NHS. As the second successive Secretary of State who has made this proposal, my right hon. and learned Friend should perhaps be entitled to the benefit of the doubt from the sceptics. I hope that in a spirit of common decency towards those who have been entrusted with such a difficult job they will think long and hard before making his job more difficult, and will allow his judgment to win the day.
On that basis, and in confidence that the evidence points in this direction, I ask the House to join us in rejecting the Lords decision and restoring the position that existed when the Bill left the Commons six months ago.

Question put, That this House doth disagree with the Lords in the said amendment:—

The House divided: Ayes 296, Noes 288.

Division No. 463]
[1.03 am


AYES


Adley, Robert
Dickens, Geoffrey


Alexander, Richard
Dicks, Terry


Alison, Rt Hon Michael
Dorrell, Stephen


Amery, Rt Hon Julian
Douglas-Hamilton, Lord James


Amess, David
Dunn, Bob


Amos, Alan
Durant, Tony


Arbuthnot, James
Dykes, Hugh


Arnold, Jacques (Gravesham)
Eggar, Tim


Arnold, Tom (Hazel Grove)
Emery, Sir Peter


Ashby, David
Evans, David (Welwyn Hatf'd)


Aspinwall, Jack
Fairbairn, Sir Nicholas


Atkins, Robert
Fallon, Michael


Baker, Rt Hon K. (Mole Valley)
Favell, Tony


Baker, Nicholas (Dorset N)
Fenner, Dame Peggy


Baldry, Tony
Field, Barry (Isle of Wight)


Banks, Robert (Harrogate)
Finsberg, Sir Geoffrey


Batiste, Spencer
Fishburn, John Dudley


Bellingham, Henry
Fookes, Miss Janet


Bendall, Vivian
Forman, Nigel


Bennett, Nicholas (Pembroke)
Forsyth, Michael (Stirling)


Benyon, W.
Forth, Eric


Biffen, Rt Hon John
Fowler, Rt Hon Norman


Blackburn, Dr John G.
Fox, Sir Marcus


Blaker, Rt Hon Sir Peter
Franks, Cecil


Body, Sir Richard
Freeman, Roger


Bonsor, Sir Nicholas
French, Douglas


Boscawen, Hon Robert
Gale, Roger


Boswell, Tim
Gardiner, George


Bottomley, Peter
Gill, Christopher


Bottomley, Mrs Virginia
Glyn, Dr Alan


Bowden, Gerald (Dulwich)
Goodlad, Alastair


Bowis, John
Goodson-Wickes, Dr Charles


Boyson, Rt Hon Dr Sir Rhodes
Gorman, Mrs Teresa


Brandon-Bravo, Martin
Gorst, John


Brazier, Julian
Gow, Ian


Bright, Graham
Grant, Sir Anthony (CambsSW)


Brittan, Rt Hon Leon
Greenway, John (Ryedale)


Brooke, Rt Hon Peter
Griffiths, Sir Eldon (Bury St E')


Brown, Michael (Brigg &amp; Cl't's)
Griffiths, Peter (Portsmouth N)


Browne, John (Winchester)
Grist, Ian


Bruce, Ian (Dorset South)
Ground, Patrick


Budgen, Nicholas
Grylls, Michael


Burns, Simon
Gummer, Rt Hon John Selwyn


Burt, Alistair
Hamilton, Hon Archie (Epsom)


Butcher, John
Hamilton, Neil (Tatton)


Butler, Chris
Hanley, Jeremy


Butterfill, John
Hargreaves, A. (B'ham H'll Gr')


Carlisle, John, (Luton N)
Hargreaves, Ken (Hyndburn)


Carlisle, Kenneth (Lincoln)
Harris, David


Carrington, Matthew
Hayward, Robert


Cash, William
Heathcoat-Amory, David


Chalker, Rt Hon Mrs Lynda
Heddle, John


Channon, Rt Hon Paul
Hicks, Mrs Maureen (Wolv' NE)


Chope, Christopher
Hill, James


Clark, Hon Alan (Plym'th S'n)
Hind, Kenneth


Clark, Dr Michael (Rochford)
Hogg, Hon Douglas (Gr'th'm)


Clark, Sir W. (Croydon S)
Hordern, Sir Peter


Clarke, Rt Hon K. (Rushcliffe)
Howard, Michael


Conway, Derek
Howarth, Alan (Strat'd-on-A)


Coombs, Anthony (Wyre F'rest)
Howarth, G. (Cannock &amp; B'wd)


Cope, Rt Hon John
Howe, Rt Hon Sir Geoffrey


Couchman, James
Howell, Ralph (North Norfolk)


Cran, James
Hughes, Robert G. (Harrow W)


Currie, Mrs Edwina
Hunt, David (Wirral W)


Curry, David
Hunter, Andrew


Davies, Q. (Stamf'd &amp; Spald'g)
Hurd, Rt Hon Douglas


Davis, David (Boothferry)
Irvine, Michael


Devlin, Tim
Jack, Michael






Jackson, Robert
Rathbone, Tim


Janman, Tim
Redwood, John


Johnson Smith, Sir Geoffrey
Renton, Tim


Jones, Gwilym (Cardiff N)
Rhodes James, Robert


Jones, Robert B (Herts W)
Riddick, Graham


Kellett-Bowman, Dame Elaine
Ridley, Rt Hon Nicholas


Key, Robert
Ridsdale, Sir Julian


King, Roger (B'ham N'thfield)
Rifkind, Rt Hon Malcolm


King, Rt Hon Tom (Bridgwater)
Roberts, Wyn (Conwy)


Kirkhope, Timothy
Roe, Mrs Marion


Knapman, Roger
Rost, Peter


Knight, Greg (Derby North)
Rumbold, Mrs Angela


Knowles, Michael
Ryder, Richard


Lamont, Rt Hon Norman
Sackville, Hon Tom


Lang, Ian
Sainsbury, Hon Tim


Lawson, Rt Hon Nigel
Sayeed, Jonathan


Lee, John (Pendle)
Scott, Nicholas


Leigh, Edward (Gainsbor'gh)
Shaw, David (Dover)


Lennox-Boyd, Hon Mark
Shaw, Sir Giles (Pudsey)


Lightbown, David
Shaw, Sir Michael (Scarb')


Lilley, Peter
Shephard, Mrs G. (Norfolk SW)


Lloyd, Sir Ian (Havant)
Shepherd, Colin (Hereford)


Lloyd, Peter (Fareham)
Shepherd, Richard (Aldridge)


Lord, Michael
Shersby, Michael


Luce, Rt Hon Richard
Skeet, Sir Trevor


Lyell, Sir Nicholas
Smith, Sir Dudley (Warwick)


Macfarlane, Sir Neil
Smith, Tim (Beaconsfield)


MacGregor, Rt Hon John
Soames, Hon Nicholas


MacKay, Andrew (E Berkshire)
Speed, Keith


Maclean, David
Spicer, Sir Jim (Dorset W)


McLoughlin, Patrick
Spicer, Michael (S Worcs)


McNair-Wilson, Sir Michael
Squire, Robin


McNair-Wilson, P. (New Forest)
Stanbrook, Ivor


Major, Rt Hon John
Stanley, Rt Hon John


Malins, Humfrey
Steen, Anthony


Mans, Keith
Stern, Michael


Maples, John
Stevens, Lewis


Marland, Paul
Stewart, Allan (Eastwood)


Marlow, Tony
Stewart, Andy (Sherwood)


Marshall, John (Hendon S)
Stewart, Ian (Hertfordshire N)


Marshall, Michael (Arundel)
Stokes, Sir John


Martin, David (Portsmouth S)
Sumberg, David


Maude, Hon Francis
Summerson, Hugo


Mawhinney, Dr Brian
Tapsell, Sir Peter


Mayhew, Rt Hon Sir Patrick
Taylor, John M (Solihull)


Mellor, David
Taylor, Teddy (S'end E)


Miller, Sir Hal
Tebbit, Rt Hon Norman


Mills, Iain
Thatcher, Rt Hon Margaret


Miscampbell, Norman
Thompson, D. (Calder Valley)


Mitchell, Andrew (Gedling)
Thompson, Patrick (Norwich N)


Mitchell, David (Hants NW)
Thorne, Neil


Moate, Roger
Thurnham, Peter


Monro, Sir Hector
Townend, John (Bridlington)


Montgomery, Sir Fergus
Townsend, Cyril D. (B'heath)


Moore, Rt Hon John
Tracey, Richard


Morris, M (N'hampton S)
Tredinnick, David


Morrison, Rt Hon P (Chester)
Trippier, David


Moss, Malcolm
Trotter, Neville


Moynihan, Hon Colin
Twinn, Dr Ian


Neale, Gerrard
Viggers, Peter


Needham, Richard
Waddington, Rt Hon David


Nelson, Anthony
Wakeham, Rt Hon John


Newton, Rt Hon Tony
Waldegrave, Hon William


Nicholls, Patrick
Walden, George


Nicholson, Emma (Devon West)
Walker, Bill (T'side North)


Onslow, Rt Hon Cranley
Walker, Rt Hon P. (W'cester)


Oppenheim, Phillip
Waller, Gary


Page, Richard
Ward, John


Paice, James
Wardle, Charles (Bexhill)


Parkinson, Rt Hon Cecil
Watts, John


Patnick, Irvine
Wheeler, John


Patten, Chris (Bath)
Whitney, Ray


Patten, John (Oxford W)
Widdecombe, Ann


Pawsey, James
Wiggin, Jerry


Porter, Barry (Wirral S)
Wilkinson, John


Porter, David (Waveney)
Wilshire, David


Portillo, Michael
Wolfson, Mark


Price, Sir David
Wood, Timothy


Raison, Rt Hon Timothy
Yeo, Tim





Young, Sir George (Acton)
Tellers for the Ayes:


Younger, Rt Hon George
Mr. Tristan Garel-Jones and



Mr. Michael Neubert.


NOES


Abbott, Ms Diane
Eastham, Ken


Allen, Graham
Evans, John (St Helens N)


Alton, David
Evennett, David


Anderson, Donald
Ewing, Harry (Falkirk E)


Archer, Rt Hon Peter
Ewing, Mrs Margaret (Moray)


Armstrong, Hilary
Fatchett, Derek


Ashdown, Paddy
Faulds, Andrew


Ashley, Rt Hon Jack
Fearn, Ronald


Ashton, Joe
Field, Frank (Birkenhead)


Atkinson, David
Fields, Terry (L'pool B G'n)


Banks, Tony (Newham NW)
Fisher, Mark


Barnes, Harry (Derbyshire NE)
Flannery, Martin


Barnes, Mrs Rosie (Greenwich)
Flynn, Paul


Barron, Kevin
Foot, Rt Hon Michael


Battle, John
Forsythe, Clifford (Antrim S)


Beckett, Margaret
Foster, Derek


Beggs, Roy
Foulkes, George


Bell, Stuart
Fraser, John


Benn, Rt Hon Tony
Fry, Peter


Bennett, A. F. (D'nt'n &amp; R'dish)
Fyfe, Maria


Bermingham, Gerald
Galbraith, Sam


Bevan, David Gilroy
Galloway, George


Bidwell, Sydney
Garrett, John (Norwich South)


Blair, Tony
Garrett, Ted (Wallsend)


Blunkett, David
George, Bruce


Boateng, Paul
Gilbert, Rt Hon Dr John


Boyes, Roland
Gilmour, Rt Hon Sir Ian


Bradley, Keith
Godman, Dr Norman A.


Bray, Dr Jeremy
Golding, Mrs Llin


Brown, Gordon (D'mline E)
Gordon, Mildred


Brown, Nicholas (Newcastle E)
Gould, Bryan


Brown, Ron (Edinburgh Leith)
Graham, Thomas


Bruce, Malcolm (Gordon)
Grant, Bernie (Tottenham)


Buchan, Norman
Gregory, Conal


Buckley, George J.
Griffiths, Nigel (Edinburgh S)


Caborn, Richard
Griffiths, Win (Bridgend)


Callaghan, Jim
Grocott, Bruce


Campbell, Menzies (Fife NE)
Hampson, Dr Keith


Campbell, Ron (Blyth Valley)
Hannam, John


Campbell-Savours, D. N.
Hardy, Peter


Canavan, Dennis
Harman, Ms Harriet


Carlile, Alex (Mont'g)
Haselhurst, Alan


Carttiss, Michael
Hattersley, Rt Hon Roy


Cartwright, John
Hawkins, Christopher


Chapman, Sydney
Hayes, Jerry


Churchill, Mr
Hayhoe, Rt Hon Sir Barney


Clark, Dr David (S Shields)
Haynes, Frank


Clarke, Tom (Monklands W)
Healey, Rt Hon Denis


Clay, Bob
Heffer, Eric S.


Clelland, David
Henderson, Doug


Clwyd, Mrs Ann
Heseltine, Rt Hon Michael


Cohen, Harry
Hicks, Robert (Cornwall SE)


Colvin, Michael
Hinchliffe, David


Cook, Robin (Livingston)
Hogg, N. (C'nauld &amp; Kilsyth)


Coombs, Simon (Swindon)
Holland, Stuart


Corbett, Robin
Holt, Richard


Cousins, Jim
Home Robertson, John


Crowther, Stan
Hood, Jimmy


Cryer, Bob
Howarth, George (Knowsley N)


Cummings, John
Howell, Rt Hon D. (S'heath)


Cunliffe, Lawrence
Howells, Geraint


Cunningham, Dr John
Hoyle, Doug


Darling, Alistair
Hughes, John (Coventry NE)


Davies, Rt Hon Denzil (Llanelli)
Hughes, Robert (Aberdeen N)


Davies, Ron (Caerphilly)
Hughes, Roy (Newport E)


Davis, Terry (B'ham Hodge H'l)
Hughes, Sean (Knowsley S)


Day, Stephen
Hume, John


Dewar, Donald
Illsley, Eric


Dixon, Don
Ingram, Adam


Dobson, Frank
Janner, Greville


Doran, Frank
Jessel, Toby


Douglas, Dick
John, Brynmor


Dover, Den
Johnston, Sir Russell


Duffy, A. E. P.
Jones, Barry (Alyn &amp; Deeside)


Dunnachie, Jimmy
Jones, Ieuan (Ynys Mön)






Jones, Martyn (Clwyd S W)
Owen, Rt Hon Dr David


Kaufman, Rt Hon Gerald
Parry, Robert


Kennedy, Charles
Patchett, Terry


Kilfedder, James
Pattie, Rt Hon Sir Geoffrey


Kinnock, Rt Hon Neil
Peacock, Mrs Elizabeth


Kirkwood, Archy
Pendry, Tom


Knight, Dame Jill (Edgbaston)
Pike, Peter L.


Knox, David
Powell, Ray (Ogmore)


Lambie, David
Prescott, John


Latham, Michael
Primarolo, Dawn


Leadbitter, Ted
Quin, Ms Joyce


Leighton, Ron
Radice, Giles


Lestor, Joan (Eccles)
Randall, Stuart


Lewis, Terry
Redmond, Martin


Litherland, Robert
Reid, Dr John


Livingstone, Ken
Richardson, Jo


Livsey, Richard
Roberts, Allan (Bootle)


Lloyd, Tony (Stretford)
Robertson, George


Lofthouse, Geoffrey
Robinson, Geoffrey


Loyden, Eddie
Robinson, Peter (Belfast E)


McAllion, John
Rogers, Allan


McAvoy, Thomas
Rooker, Jeff


McCartney, Ian
Ross, Ernie (Dundee W)


McCrea, Rev William
Ross, William (Londonderry E)


McCrindle, Robert
Ruddock, Joan


Macdonald, Calum A.
Salmond, Alex


McFall, John
Sedgemore, Brian


McGrady, Eddie
Sheerman, Barry


McKay, Allen (Barnsley West)
Sheldon, Rt Hon Robert


McKelvey, William
Short, Clare


McLeish, Henry
Skinner, Dennis


Maclennan, Robert
Smith, Andrew (Oxford E)


McNamara, Kevin
Smith, C. (Isl'ton &amp; F'bury)


McTaggart, Bob
Smyth, Rev Martin (Belfast S)


McWilliam, John
Snape, Peter


Madden, Max
Soley, Clive


Madel, David
Spearing, Nigel


Maginnis, Ken
Steel, Rt Hon David


Mahon, Mrs Alice
Steinberg, Gerry


Mallon, Seamus
Stott, Roger


Marek, Dr John
Strang, Gavin


Marshall, David (Shettleston)
Straw, Jack


Marshall, Jim (Leicester S)
Taylor, Mrs Ann (Dewsbury)


Martin, Michael J. (Springburn)
Taylor, Matthew (Truro)


Martlew, Eric
Thomas, Dr Dafydd Elis


Mates, Michael
Thompson, Jack (Wansbeck)


Maxton, John
Turner, Dennis


Maxwell-Hyslop, Robin
Vaughan, Sir Gerard


Meacher, Michael
Vaz, Keith


Meale, Alan
Walker, A. Cecil (Belfast N)


Meyer, Sir Anthony
Wall, Pat


Michael, Alun
Wallace, James


Michie, Bill (Sheffield Heeley)
Walley, Joan


Michie, Mrs Ray (Arg'l &amp; Bute)
Wardell, Gareth (Gower)


Mitchell, Austin (G't Grimsby)
Wareing, Robert N.


Molyneaux, Rt Hon James
Welsh, Andrew (Angus E)


Moonie, Dr Lewis
Wigley, Dafydd


Morgan, Rhodri
Williams, Rt Hon Alan


Morley, Elliott
Williams, Alan W. (Carm'then)


Morris, Rt Hon A. (W'shawe)
Wilson, Brian


Morris, Rt Hon J. (Aberavon)
Winnick, David


Morrison, Sir Charles
Winterton, Mrs Ann


Mowlam, Marjorie
Winterton, Nicholas


Mullin, Chris
Wise, Mrs Audrey


Murphy, Paul
Worthington, Tony


Nellist, Dave
Wray, Jimmy


Nicholson, David (Taunton)
Young, David (Bolton SE)


Oakes, Rt Hon Gordon



O'Brien, William
Tellers for the Noes:


O'Neill, Martin
Mr. Frank Cook and


Orme, Rt Hon Stanley
Mr. Allen Adams.

Question accordingly agreed to.

Amendments (b) to (d) to the words so restored to the Bill agreed to.

Consequential amendments (e) and (f) agreed to.

Lords amendment No. 23 disagreed to.

Amendment (b) to the words so restored to the Bill agreed to.

Lords amendment Nos. 24 and 25 agreed to. [Special Entry].

Lords amendment No. 26 disagreed to.

Amendments (b) to (d) to the words so restored to the Bill agreed to.

Consequential amendments (e) and (f) agreed to.

Lords amendments Nos. 22 and 28 agreed to. [Special Entry].

Clause 13

GENERAL OPHTHALMIC SERVICES AND OPTICAL APPLIANCES

Lords amendment: No. 29, in page 17, line 45, at end insert—

(3) The following subsections shall he inserted after subsection (1) of section 21 of the Opticians Act 1958 (restriction on sale and supply of optical appliances)—
( I A) Subsection (1) above does not apply to an excluded sale.
(1B) In subsection (IA) above "excluded sale" means a sale for a person not under the age of 16 of spectacles which have two single vision lenses of the same positive spherical power not exceeding 4 dioptnes, where the sale is wholly for the purpose of correcting, remedying or relieving the condition known as presbyopia; and for the purposes of this subsection lenses are to be taen to have the same positive spherical power if the difference between them is within the tolerances relating to the power of such lenses specified from time to time in the British Standard Specification.

(4) In subsection (2) of that section for the words "the foregoing subsection" there shall be substituted the words "Subsection (1) of this section."

Mrs. Currie: I beg to move, That this House doth agree with the Lords in the said amendment.

Mr. Speaker: With this it will be convenient to discuss Lords amendment No. 41.

Mrs. Currie: Amendment No. 29, and Nos. 41 and 43 which apply to Northern Ireland, will allow the sale of reading glasses to adults without a prescription. In the other place that principle was agreed in Committee following a free vote on the Government side. However, as the amendment tabled by the noble Lord Winstanley had certain defects and did not provide a safeguard for children under 16, the Government brought forward a tidying-up amendment to give effect to the wishes of another place.
The arguments about the sale of reading glasses without a prescription have raged for many years, with each side putting its case forcefully. It is generally accepted, however, that wearing self-selected glasses will not harm adults' eyes, even if they are the wrong strength. I remind the House that the original motion was tabled in another place by Lord Winstanley, who is a qualified doctor, and that he has been supported publicly by such people as Professor Barrie Jay of the Moorfields eye hospital, who says that there is no evidence from other countries such as the United States, where off-the-shelf spectacles have long been available, that people a re harmed if they choose glasses that do not give them perfect sight correction.
Indeed, many other countries including New Zealand, Holland, Italy, Sweden, Canada and almost all states of the USA allow the sale of reading glasses, seemingly without adverse consequences for the populations' eyes. If-


there were any evidence of significant problems in, for example, the United States, where there is derestriction, I would have thought that the movement would have been very much in the other direction.

Mr. Campbell-Savours: Does the Minister accept that if the amendment stands, people can go into a shop, buy spectacles without a prescription and so bypass what many believe to be an essential eye check during which major medical problems may be diagnosed?

Mrs. Currie: Yes, that is exactly what is being suggested. The concern underlying the hon. Gentleman's quesion is probably taken care of by some of the research in the United States. For example, in a study of 15,000 eye-glass wearers in states where reading glasses are now sold over the counter, 79 per cent. of those questioned said that they still had professional eye examinations. We believe that more competition, lower prices and more convenience will far outweigh some of the difficulties that the hon. Gentleman mentioned. That is also why the Government brought forward an amendment to ensure that there is particular protection for, for example, children under 16.

Mr. Maxwell-Hyslop: How will the 16-year-old cut-off point be policed? We must bear in mind the absurd difficulty of preventing people under 18 buying alcohol from off-licences, which is the best example of lack of policing.

Mrs. Currie: It would be illegal to sell such spectacles to children under 16, in the same way as it is illegal to sell them a number of other things. I have not the least doubt that opticians, especially as led by the General Optical Council, will keep an eye on these matters.
I repeat that we have no evidence that purchasing the wrong spectacles can cause harm to the eyes. The people whom we hope to help by accepting the amendment are those in my age group, the 40s, when eyesight begins to deteriorate very slightly but where evidence of eye disease is extremely rare.

Mr. Allen McKay: Does the hon. Lady accept that people drive wearing glasses? Does she further accept that there can be a difference between one eye and the other and that that cannot be catered for when buying glasses over the counter?

Mrs. Currie: I am not sure of the relevance of the hon. Gentleman's first point. I certainly hope that anyone with defective eyesight drives wearing glasses. The hon. Gentleman is right about eyes being different. I understand that the proposal would allow only spectacles with both lenses of the same strength. That is a safeguard as anyone who found such an eye difference when they tried to purchase the spectacles would be well advised to have an eye test.
As I have said, in the United States where people have to pay for their eye tests, the overwhelming majority of those who purchase spectacles go to their advisers and have the appropriate tests. There is no reason why that should not be the case in this country. I merely offer the House a comment made in the leader in the New York Times on 16 May.

Q: What's the difference between $60 reading glasses prescribed by an optometrist in New York and a $12 pair from Woolworth's in New Jersey?
A: $48.
In our view, the Lords have been wise in their approach to this subject, and we commend their amendment to the House.

Mr. Galbraith: The Minister is being somewhat disingenuous in trying to pretend that the argument against the amendment is based on whether the spectacles one gets may or may not affect one's sight simply because those spectacles may or may not make the right correction. The true argument against it is based in part on our earlier discussion about whether people will obtain glasses without prescription and therefore without having had their eyes tested.
We have already rehearsed the arguments about the value of eye tests and I will not repeat them. Without wishing to quote any scare stories over this issue, I must emphasise that it is essential that people having trouble with their eyesight should have their eyes examined by a properly qualified person before obtaining spectacles.
The amendment will undoubtedly result in many people not having their eyes properly tested, so leading to a deterioration in sight, due not to the refractive index within the spectacles but because some people will have ocular disease which will not be diagnosed.

Miss Ann Widdecombe: Because of the courteous and helpful replies that I have received from Ministers, I no longer speak with the acute anxiety that I felt when I first became aware of the amendment. But I still retain more than lingering traces of deep unease, and they require further assurances if they are to be eradicated completely.
I remain wholly in favour of the charges which we have voted to introduce and I still do not believe that they will act as a serious deterrent. But in this case the Government appear to be saying that people should have a prescription and a proper eye test because that is good preventive medicine, while at the same time saying that it is not necessary to have an eye test.
The Government's endorsement of the lack of necessity for an eye test will be a greater deterrent to people to have eye tests than any charge, however high. I say that because if people need new spectacles, or need glasses for the first time and they have no choice but to get a prescription, they will have their eyes tested whatever the charge.
An exaggerated picture may have been painted of the incidence of eye disease as opposed to eye defects which can be discovered during an optician's test, but it is common ground that a significant percentage of eye disease is diagnosed in such tests.
Under the amendment, a person aged 40 to 50 who has had consistently good sight but finds difficulty with reading, or some other minor difficulty, will probably say, "I do not need a prescription. I will simply buy a pair of glasses that will magnify." Even if the difficulty that that person has been experiencing is indicative of something more serious, he or she will not find out.
It has been pointed out that no person's two eyes are alike. Buying ready-made spectacles across the counter will mean that people will buy glasses with two lenses exactly alike.
It would be foolish to disregard the medical opinion which suddenly says that it is not so important to have a prescription, and that the wrong spectacles will not do much damage. Nevertheless, I am uneasy. If it is true that no damage is done to adult sight by wearing the wrong type of spectacles—given that they are simple magnifying spectacles—why were we so insistent when the sale of frames was deregulated that the lenses for them had to continue to be prescribed? Has medical opinion changed so radically that the argument has suddenly been stood on its head? If we are so convinced that there is no problem with adult sight, why did not the Government propose the amendment, rather than leaving it to the other place to do so? I issue a simple challenge to the practitioners who say that adult sight will not be damaged. Would they be prepared to put the wrong spectacles on their nose and wear them consistently for any length of time, and if they did, would they be confident that they would do themselves no long-term damage?
I fear the danger that if we get into the habit of thinking that we can buy spectacles without prescription and that it will do no harm, a market for second-hand glasses will develop. At that point we shall lose control. It will no longer be a case of telling people that they can buy only magnifying glasses. We shall lose control over the type of glasses sold. Many people will be deceived into thinking that they need simple magnification—nothing more than could be achieved with an ordinary hand-held magnifying glass—when in fact they need something more sophisticated. They will go without the spectacles that they need and when they find after two years that their sight has deteriorated they may think that all that they need is a stronger pair of magnifying spectacles. Once again they will buy them without prescription.
I do not wholly disregard the medical opinion that the problem may not be as serious as all that, but I seek some assurances. First, will the money which is rightly being rechannelled into preventive medicine include money for an immense education campaign about the value of the eye test? Will people be told that prescribed glasses are preferable to those that one can buy over the counter? Secondly, can we have a guarantee that the arrangements will be properly policed to ensure that only simple magnifying glasses and nothing more sophisticated are sold over the counter? Will any provision be made to discourage those who are returning for their second pair of non-prescribed spectacles—perhaps a statutory Government health warning that non-prescribed spectacles may, in the end, damage their sight? Will something be done to encourage people to choose properly prescribed lenses as a first step?

Mr. Campbell-Savours: I propose to intervene briefly. I had intended to speak at length but I do not think that that would be helpful given that it is 1.40 am. [HoN. MEMBERS: "Hear, hear."]
In our earlier debate, the Secretary of State said that on the previous occasion on which these matters had come before the House he had been right. He maintained that when deregulation was being discussed by the House in 1983 he countered a number of predictions made from the Labour Front Bench and that he was right. Perhaps he was right, but there is a distinction between that debate and this. On that occasion, all the right hon. and learned Gentleman's hon. Friends supported him. He may be surprised to learn that a number of Opposition Members

—including me—also supported his position on deregulation in 1983. We argued the matter on the Labour Benches, but our view did not prevail. On this occasion, however, Conservative Members are divided and the Opposition are united. I do not think that the Secretary of State has understood the importance of that difference.
The Minister referred to the market in non-prescribed spectacles in the United Slates of America. I was in America a couple of months ago and I bought two pairs of spectacles in a Washington store. I paid $7 for one pair and $15 for another—the equivalent of about £5 and £9. It struck me when I bought those glasses how cheap they were, so when I returned to the United Kingdom I invited a gentleman from, I think, the College of Ophthalmists to the Commons to tell me how one could justify spectacles being so much cheaper in the United States of America. He said that his organisation was not, in principle, opposed to the sale of cheap spectacles.
Although I shall be voting in the same way as the hon. Member for Birmingham, Edgbaston (Dame J. Knight), I am not here to argue against the supply of free spectacles. If people want cheap spectacles, let them have them. The question is whether they should be allowed to have cheap spectacles without being given a prescription or some form of sight test. Should we allow a select group of people through this important net during which a medical condition might be diagnosed with not only long term implications for them, but for the Exchequer, in that the National Health Service may have to treat them. We are not arguing against the need for an over-the-counter market to develop in cheap spectacles. I accept that and if opticians believe in real competition, they, too. would support that principle. What they are saying is that people should have a prescription to buy them.
Perhaps a prescription can be modified so that it refers to magnification in terms of two, two and a half, three or whatever. It might be simplified to the extent that the person for whom spectacles are being prescribed can go to the opticians or to Underwoods, Boots or Woolworth's and buy a pair of spectacles over the counter. The point is that we must retain the net through which people must go before they are allowed to buy spectacles freely in the market, because the net is so precious in identifying disease.
I am sorry that so many hon. Members have left the House, and we will have difficulty, clearly, commanding a majority in the Lobby. Even at this late stage, I believe that the Minister should be aware of the concerns that have been expressed. When she replies to the debate, will she comment on the statistics that she gave us earlier? She said that an opinion poll had been carried out in the United States which showed that 79 per cent. of those who were buying spectacles on the over-the-counter market and in stores had had sight tests. That begs two questions. What about the 21 per cent. who had not? That means that millions of people have by-passed sight tests in America. Does the Minister accept that there may be millions of people who have slipped through the net?

Mr. Michael Shersby: I wish to disclose an interest, because I was recently consulted by the Federation of Ophthalmic and Dispensing Opticians on this matter. I want to probe the reason given by the Minister for supporting the Lords amendment. It seems to me that she rested her case for this substantial change in the Government's policy on the research carried out in the


United States. Can she tell the House when that research was carried out, what the research showed and why it was sufficiently powerful to change long-established Government procedure on this matter? As the hon. Member for Workington (Mr. Campbell-Savours) said, as long ago as 1983 the then Secretary of State for Social Services, my right hon. Friend the Member for Sutton Coldfield (Mr. Fowler), made it clear that the determination of the Government was not to bow to pressure from those who advocated the lifting of all restrictions on the dispensing of spectacles to adults.
The Office of Fair Trading also considered the matter and reported that if Ministers felt that the potential health risks outweighed competition benefits, it would consider the alternative of derestricting dispensing provided that spectacles could only be sold against a prescription issued in, say, the previous two or three years. That view was expressed in 1983.
Earlier this year, in fact in Committee, my right hon. Friend the Member for Braintree (Mr. Newton) stated:
we are clear that the law does not, nor is it our intention that it should, allow people to walk off the street into any shop that cares to display spectacles and to buy spectacles that have no relation to some measurement of what their eyes need."—[Official Report, Standing Committee A, 11 February 1988; c. 660.]
1.45 am
Those are two clear statements of Government policy, by the former Secretary of State and by the former Minister for Health, made only a few months ago.
I should like to make it clear to the House that, as I understand it, the Federation of Ophthalmic and Dispensing Opticians does not claim that ready-made spectacles are harmful to the eyes. It is concerned about missed eye examinations. Its serious objection to ready-made spectacles for adults over 40 is that almost inevitably such a person would be likely to miss an opportunity for a proper eye examination, yet the very people likely to buy ready-made spectacles are presbyopes over the age of 40 for whom a health screening check is most important.
Even at such a late hour, these are important points and I shall be extremely grateful if my hon. Friend will explain to the House a little more clearly why there has been such a substantial reversal of long-standing Government policy and why, on the basis of unspecified American research, it is proposed to agree with the Lords amendment.

Mr. Nigel Griffiths: It is significant that all the Back-Bench speeches in the debate have been hostile to the Government's view. It is interesting that the two speeches from the Conservative Back Benches have been from hitherto noted Government loyalists. That tells me, the House and the country that there is considerable all-party disquiet about the Government's refusal to accept the amendment. That disquiet arises from the fact that an amendment previously supported by the hon. Member for Birmingham, Edgbaston (Dame J. Knight) might well have enabled us to avoid this debate as it would have accepted that free eye tests mean that people are not reluctant to go to their optician to get a professional view and a professional prescription, which they can then take to a supermarket-type facility.

I am particularly critical of the price of spectacles in this country. It is interesting that all the Government's moves to reduce the price of spectacles have in my view and in that of my constituents had little impact on high street shops.
The experience of America appears to be unreliable. I believe that the Under-Secretary, the hon. Member for Derbyshire, South (Mrs. Currie), gave the game away when she talked about the quality of the people passing judgment in the United States. She did not talk about optometrists or about qualified opticians. Her words were "eye advisers". What qualifications do those "eye advisers" have to dispense spectacles? I suggest that such people do not have any qualifications—

Mrs. Currie: I am not sure whether the hon. Gentleman heard me. I called in evidence Professor Jay, ex-president of the Faculty of Ophthalmologists and a consultant at Moorfields eye hospital, who has said that there is no evidence that choosing such spectacles causes any medical problems.

Mr. Griffiths: The Minister's comments are irrelevant. She has not sought to refute the fact that, as the record will show, she referred to eye advisers, not qualified opticians or optometrists. That betokens a phrase to denote people who are not qualified and are selling cameras or films over the counter one day and are calling themselves eye advisers and selling glasses the next, as if they were operating a fast food franchise. We might have some faith in eye advisers if they were qualified and could ensure that prescriptions were made up to suit people's eyes, but the Government deliberately voted tonight to ensure that that does not happen free of charge. That explains the opposition to the measure and why no Conservative Back Benchers have spoken in favour of it.
The Minister has not taken into account the difference in traditions between this country and the United States. In the United States, people are accustomed to paying for glasses and eye tests. The United States has never boasted a free health service when people need it, paid for by taxes. People in the United States must look out for themselves and look to their own resources. That tradition may serve people in the immediate future, but the incidence of glaucoma and other eye diseases may be higher in the United States than it is here because people are not screened so early. I choose my words advisedly and say "may". If the Minister is prepared to present evidence to the House— I give her the opportunity to do so—I will withdraw the word "may". However, as she is not rising to intervene, I am minded to change the word "may" and say, "The likely fact is that the incidence is greater."
Since the war, we have had a tradition of free eye tests which has been supported by all political parties, until now, the profession and the country. The Government will save peanuts as a result of the measure that they forced through earlier by so narrow a majority. People in this country are accustomed to free eye tests. Conservative Members are right to say that nothing is free because those tests are paid for through taxes.
People are entitled to one professional consultation a year to have their eyes tested. Without that, the sales of glasses over the counter will not be a boon to the country, but will deceive many people into thinking that they are receiving medical treatment when they are being conned by unqualified over-the-counter salesmen. That will result


in increased eye disease and increased cost to the National Health Service, as diseases will be detected much later than at present, and the people who will have to pick up the bills will be the taxpayers.

Dame Jill Knight: My name appears against amendment (a) to Lords amendment No. 29, and I have waited patiently to speak to it. I do not want to detain the House for long, but I wish to make one or two points that have not yet been drawn to the attention of the House. I remember vividly—this happened when I first became a Member of this place—a Bill that was moved and piloted through the House by the late Sir Ronald Russell, who represented Wembley. The arguments advanced against the then common practice of having ready-made spectacles available in Woolworth stores, for example, were extremely powerful. Sir Ronald had no difficulty in securing a place for his Bill on the statute book.
It is extremely unfortunate that we are going back on Sir Ronald's arguments and his Bill. In those days we thought that it was wrong for ready-made spectacles to be available for purchase in ordinary retail outlets, and it is sad that that principle is now being overthrown. Ministers made firm promises during the early stages of the Bill's passage through Parliament that this very thing would not happen. Clause 14(1) has been amended by the Government to require the Secretary of State to regulate all the duties that are to be performed in a sight test. What is the point of that if there is not to be a sight test in many instances?
Practically everyone on earth has two eyes that are different. Another fact, and a continuing one, is that every two lenses in every pair of ready-made glasses are the same. It is not possible for someone to pick up a pair of ready-made glasses that meet his or her needs exactly. I have far too much respect for my eyes to risk damaging them by wearing ready-made glasses. Is it certain that the provision of ready mades will deter the public from bothering to arrange eye tests and obtaining proper glasses.
When the Bill is enacted and implemented, the cost of an eye test will increase, and the public will be able to pick up a pair of glasses in a Woolworth store, for example, or from a barrow in the local market. What sort of arrangement is that?
Clause 13, as amended, excludes the sale of ready-made glasses to under 16-year-olds. That is ridiculous. How will that provision be policed? Will inspectors wander around ready to pounce on 15-year-olds who are seen hovering near the ready-made glasses counter in a Woolworth store? The licensees of pubs cannot identify young people who are under 16, and perhaps the difficulties of licensees are not so great as those that will be faced by inspectors. After all, some young people sit in pubs for comparatively long periods with drinks in their hands, and for much longer than it would take a 15-year-old to buy a pair of ready-mades. It is lunacy to pretend—

Mrs. Audrey Wise: Will the hon. Lady give way?

Dame Jill Knight: No, I shall not give way. I am trying to be brief.
If it is lunacy to pretend that there can be effective policing, why are 16-year-olds excluded from the sale of ready-made glasses?

I apologise to the House for introducing two highly technical issues. Theoretically, it is impossible for there to be presbyopia of more than three dioptrics, but ready-mades are said to be for persons suffering from presbyopia. The provision permits reading glasses to be sold up to plus four dioptres in power, but they could not possibly be sold wholly for the purpose that the Bill stipulates. That is ridiculous nonsense.
I concede that ready-made glasses may not harm people's eyes, but it can be said with certainty that those who wear such glasses will not be able to see properly. The glasses will not be optically correct. Double vision could easily be caused if the optical centres of the lenses did not coincide with the exact distance between the person's eyes. If someone had double vision, he will be extremely dangerous when behind the wheel of a car. Unfortunately, drivers will buy ready-made glasses, put them on their noses, drive their cars and hit something. They will not be able to see properly. There is no doubt about that. There are many examples of that happening in America. If drivers have a tendency to experience double vision because they wear optically incorrect glasses, they will be especially dangerous when driving at night. Alternatively, someone wearing optically incorrect glasses could enter a factory and operate a lathe without being able to see properly.
We have already taken one step towards eliminating eye tests, and this is a second and extremely serious step. If my hon. Friend the Minister and her ministerial colleagues are sincere in wanting the public to have eye tests, this is the wrong way to proceed. I ask them to accept the amendment.

2 am

Mr. Geoffrey Dickens: I support the Government. Every hon. Member who has spoken so far has treated the general public like imbeciles. If a member of the public selects a pair of ready-made glasses, he wants them for reading. If the glasses are comfortable for both eyes and he can read well, those glasses will do very nicely thank you and will do no harm to the eyes.
If a member of the general public needs distance glasses with different lenses, he will have to get a prescription. If he is not well or has eye trouble, he will go to his general practitioner. One of the first things that the general practitioner will do is get a torch and look into his eyes. That is a diagnostic approach used by doctors.
I believe that members of the public are very sensible. If they are not well and have eye trouble, they will go to a doctor or a proper optician. Most people believe that their eyesight is their most precious possession. Whatever priorities they may have or whatever else they may have to cut back on, it is certain that they will still go for an eye test.
The Minister referred to the American figures. I suspect that the people who did not enter that category were excluded because they did not have great defects. Therefore, the glasses that they acquired off the shelf in a shop were adequate for their correction and suited them nicely. Some hon. Members have implied that people will crash into others in cars, knock into people and all that stupid nonsense. If that happens when someone puts On


glasses, he will get the right glasses or a prescription. We must begin to treat people as intelligent human beings and not as imbeciles.
I was a member of the Standing Committee on the Health and Social Security Bill which became the Health and Social Security Act 1985. That deregulation Bill was shepherded through the House by my right hon. and learned Friend the Secretary of State when he was Minister for Health. That legislation has worked well. If we want inexpensive glasses we can acquire them, but if we want to pay a little extra for fashion we can do that. The vast majority of people will go to proper opticians. All the scaremongering is absolutely stupid. The Government are on the right lines. Opposition Members said that no Conservative Members would speak in favour of the proposal. I speak in favour and I think that I have spoken more commonsense than the rest of the speakers put together.

Mrs. Currie: I am sure that all hon. Members would join me in saying that we would never treat my hon. Friend the Member for Littleborough and Saddleworth (Mr. Dickens) like an imbecile because he clearly is not one and never has been.
My hon. Friend the Member for Maidstone (Miss Widdecombe) asked about having an immense education programme. We have already set aside £250,000 this year and we are considering whether we should set aside a similar sum next year. We look for sensible proposals from the profession which would answer many of the concerns expressed tonight.
My hon. Friend asked whether they would be simple glasses. I suggest that she looks at the detailed wording of the amendment. We adopted four dioptres because the professional advice was that that was a sensible cut-off point. As for a Government health warning, I shall consider what she has said, but, in all honesty, since the spectacles cause no harm we do not feel that that is necessary. I see that my hon. Friend is about to rise again. I hope that she will allow me to answer the other points and it may be that I will cover those that she has made.
I listened to my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) with great care. I have the greatest possible respect for her. When I was a new councillor in Birmingham she was the local Member of Parliament and she treated me at all times with consideration and courtesy. However, I do not agree with a word that she has said.
In all honesty, this was not Government policy originally. It was not in the Bill. It was drafted by one of the nation's distinguished doctors, the noble Lord Winstanley. After some discussion, and after taking medical and optical advice, we decided that the best thing to do was to offer Conservatives a free vote. They had a full discussion and the other place decided to proceed, having taken into account many of the arguments that were put. It is now argued that the House should concur with the Lords in the amendment and take into account the advice that was given by a large number of medically qualified people.
My hon. Friend said that people would not be able to see properly. My hon. Friend the Member for Littleborough and Saddleworth put it very well. He said that if they cannot see properly they had better get

themselves some proper spectacles and that is what they would do. In all honesty, having given the matter considerable thought, the Government consider it highly unlikely that we shall end up with drivers with double vision at night toddling around wearing spectacles that are no use for them simply because the amendment comes into operation. We consider that it is a splendid small change that will widen the market. It will make it simple, easy and convenient for people with mild vision defects to purchase spectacles should they so want. It will do no harm and it may do some good.

Mr. Campbell-Savours: Before the hon. Lady sits down—

Mr. Deputy Speaker (Mr. Harold Walker): Order. The hon. Lady has sat down.

Question put, That this House doth agree with the Lords in the said amendment:—

The House divided: Ayes 224, Noes 30.

Division No. 464]
[2.06 am


AYES


Alexander, Richard
Curry, David


Alison, Rt Hon Michael
Davies, Q. (Stamf'd &amp; Spald'g)


Amess, David
Davis, David (Boothferry)


Amos, Alan
Day, Stephen


Arbuthnot, James
Devlin, Tim


Arnold, Jacques (Gravesham)
Dickens, Geoffrey


Arnold, Tom (Hazel Grove)
Dorrell, Stephen


Ashby, David
Douglas-Hamilton, Lord James


Atkins, Robert
Durant, Tony


Baker, Rt Hon K. (Mole Valley)
Emery, Sir Peter


Baker, Nicholas (Dorset N)
Evans, David (Welwyn Hatf'd)


Batiste, Spencer
Fairbairn, Sir Nicholas


Bendall, Vivian
Fallen, Michael


Bennett, Nicholas (Pembroke)
Favell, Tony


Bonsor, Sir Nicholas
Fearn, Ronald


Boscawen, Hon Robert
Fenner, Dame Peggy


Boswell, Tim
Field, Barry (Isle of Wight)


Bottomley, Peter
Fishburn, John Dudley


Bottomley, Mrs Virginia
Forman, Nigel


Bowden, Gerald (Dulwich)
Forsyth, Michael (Stirling)


Bowis, John
Franks, Cecil


Boyson, Rt Hon Dr Sir Rhodes
Freeman, Roger


Brazier, Julian
French, Douglas


Bright, Graham
Gale, Roger


Brooke, Rt Hon Peter
Gardiner, George


Brown, Michael (Brigg &amp; Cl't's)
Goodlad, Alastair


Browne, John (Winchester)
Gorman, Mrs Teresa


Bruce, Ian (Dorset South)
Gorst, John


Bruce, Malcolm (Gordon)
Gow, Ian


Burns, Simon
Greenway, John (Ryedale)


Burt, Alistair
Griffiths, Peter (Portsmouth N)


Butcher, John
Grist, Ian


Butler, Chris
Ground, Patrick


Butterfill, John
Hamilton, Hon Archie (Epsom)


Campbell, Menzies (Fife NE)
Hamilton, Neil (Tatton)


Carlile, Alex (Mont'g)
Hanley, Jeremy


Carlisle, Kenneth (Lincoln)
Hargreaves, A. (B'ham H'll Gr')


Carrington, Matthew
Hargreaves, Ken (Hyndburn)


Cash, William
Harris, David


Chalker, Rt Hon Mrs Lynda
Haselhurst, Alan


Channon, Rt Hon Paul
Hayward, Robert


Chapman, Sydney
Heathcoat-Amory, David


Chope, Christopher
Heddle, John


Clark, Sir W. (Croydon S)
Heseltine, Rt Hon Michael


Clarke, Rt Hon K. (Rushcliffe)
Hind, Kenneth


Colvin, Michael
Hogg, Hon Douglas (Gr'th'm)


Conway, Derek
Howard, Michael


Coombs, Anthony (Wyre F'rest)
Howarth, Alan (Strat'd-on-A)


Coombs, Simon (Swindon)
Howarth, G. (Cannock &amp; B'wd)


Cope, Rt Hon John
Hughes, Robert G. (Harrow W)


Couchman, James
Hunt, David (Wirral W)


Cran, James
Hunter, Andrew


Currie, Mrs Edwina
Irvine, Michael






Jack, Michael
Oppenheim, Phillip


Janman, Tim
Page, Richard


Jessel, Toby
Paice, James


Jones, Gwilym (Cardiff N)
Patrick, Irvine


Jones, Robert B (Herts W)
Patten, Chris (Bath)


King, Roger (B'ham N'thfield)
Patten, John (Oxford W)


Kirkhope, Timothy
Pawsey, James


Knapman, Roger
Porter, David (Waveney)


Knight, Greg (Derby North)
Portillo, Michael


Knowles, Michael
Raffan, Keith


Knox, David
Raison, Rt Hon Timothy


Lang, Ian
Rathbone, Tim


Lawson, Rt Hon Nigel
Redwood, John


Lee, John (Pendle)
Renton, Tim


Leigh, Edward (Gainsbor'gh)
Rhodes James, Robert


Lennox-Boyd, Hon Mark
Riddick, Graham


Lightbown, David
Ridley, Rt Hon Nicholas


Lilley, Peter
Roe, Mrs Marion


Lloyd, Peter (Fareham)
Rumbold, Mrs Angela


Lord, Michael
Ryder, Richard


Lyell, Sir Nicholas
Sackville, Hon Tom


MacGregor, Rt Hon John
Sainsbury, Hon Tim


Maclean, David
Sayeed, Jonathan


McLoughlin, Patrick
Scott, Nicholas


Major, Rt Hon John
Shaw, David (Dover)


Malins, Humfrey
Shaw, Sir Michael (Scarb')


Mans, Keith
Shephard, Mrs G. (Norfolk SW)


Marland, Paul
Shepherd, Colin (Hereford)


Marshall, John (Hendon S)
Smith, Sir Dudley (Warwick)


Marshall, Michael (Arundel)
Smith, Tim (Beaconsfield)


Maude, Hon Francis
Soames, Hon Nicholas


Mayhew, Rt Hon Sir Patrick
Spicer, Sir Jim (Dorset W)


Mellor, David
Spicer, Michael (S Worcs)


Meyer, Sir Anthony
Squire, Robin


Miller, Sir Hal
Stanbrook, Ivor


Mills, Iain
Stanley, Rt Hon John


Mitchell, Andrew (Gedling)
Stern, Michael


Mitchell, David (Hants NW)
Stevens, Lewis


Monro, Sir Hector
Stewart, Andy (Sherwood)


Moore, Rt Hon John
Sumberg, David


Morris, M (N'hampton S)
Summerson, Hugo


Morrison, Sir Charles
Tapsell, Sir Peter


Moss, Malcolm
Taylor, John M (Solihull)


Moynihan, Hon Colin
Tebbit, Rt Hon Norman


Neale, Gerrard
Thatcher, Rt Hon Margaret


Newton, Rt Hon Tony
Thompson, D. (Calder Valley)


Nicholls, Patrick
Thompson, Patrick (Norwich N)


Nicholson, David (Taunton)
Thurnham, Peter


Nicholson, Emma (Devon West)
Trippier, David


Onslow, Rt Hon Cranley
Trotter, Neville





Twinn, Dr Ian
Widdecombe, Ann


Viggers, Peter
Wilshire, David


Waddington, Rt Hon David
Wolfson, Mark


Wakeham, Rt Hon John
Wood, Timothy


Walker, Bill (T'side North)
Yeo, Tim


Ward, John
Young, Sir George (Acton)


Wardle, Charles (Bexhill)
Younger, Rt Hon George


Warren, Kenneth



Watts, John
Tellers for the Ayes:


Wheeler, John
Mr. Tristan Garel-Jones and


Whitney, Ray
Mr. Michael Neubert.


NOES,


Banks, Tony (Newham NW)
McKay, Allen (Barnsley West)


Barnes, Harry (Derbyshire NE)
Mallon, Seamus


Battle, John
Maxwell-Hyslop, Robin


Beggs, Roy
Nellist, Dave


Canavan, Dennis
Pike, Peter L.


Cohen, Harry
Ross, William (Londonderry E)


Cook, Robin (Livingston)
Salmond, Alex


Ewing, Mrs Margaret (Moray)
Skinner, Dennis


Foster, Derek
Spearing, Nigel


Fyfe, Maria
Wareing, Robert N.


Galbraith, Sam
Welsh, Andrew (Angus E)


Godman, Dr Norman A.
Winnick, David


Griffiths, Nigel (Edinburgh S)
Wise, Mrs Audrey


Hume, John



Lloyd, Tony (Stretford)
Tellers for the Noes:


McAvoy, Thomas
Mr. Bob Cryer and


McGrady, Eddie
Mr. D. N. Campbell-Savours

Question accordingly agreed to.

Lords amendments Nos. 30 to 51 agreed to, some with special entry.

Ordered,
That a Committee be appointed to draw up a reason to be assigned to the Lords for disagreeing to their amendment No. 20.

Ordered,
That Mr. Secretary Clarke, Mr. Davud Mellor, Ms. Harriet Harman and Mr. Tom Sackville be members of the Committee.

Ordered,
That three be the quorum of the Committee.

Ordered,
That the Committee do withdraw immediately.— [Mr. Kenneth Clarke.]

Reason for disagreeing to Lords amendment reported, and agreed to; to be communicated to the Lords.

Motor Vehicles (Air Pollution)

The Parliamentary Under-Secretary of State for Transport (Mr. Peter Bottomley): I beg to move,
That this House takes note of European Community Document No. 4637/88 and the Supplementary Explanatory Memorandum submitted by the Department of Transport on 8th July on air pollution by the gases from the engines of motor vehicles; and supports the agreement reached at the 28th and 29th June Environment Council in Luxembourg.
We are considering a proposal from the Commission that deals with future standards for gaseous emissions from cars with engines of less than 1·4 litres.
When the "Luxembourg package", which later became directive 88/76, was negotiated in 1985, the Community put off one of its toughest decisions. It set only interim first stage standards for small cars, which form about half the European car market. The proposal now before us seeks to set definitive stage II standards for these vehicles. The word "definitive" is used imprecisely. The 88/76 directive is the fifth amending directive to the original one that set emission limits back in 1970. This latest draft directive now has an additional article committing the European Council to consider in 1991 another tightening of standards for all sizes of car.
It is proposed that the stage II small cars type approval limit value for carbon monoxide should be 30 g per test and the combined total of hydrocarbons and oxides of nitrogen 8 g per test. The limits are the same as those to be applied for medium-sized cars, between 1·4 and 2 litres, and nearly as strict as the United States equivalent limits set for cars over 2 litres.

Mr. Greg Knight: I am grateful to my hon. Friend for giving way. As he is probably aware, many thousands of motorists in Great Britain drive classic or vintage motor vehicles which are incapable of being modified to meet the requirements. I have read the documents and I am satisfied that those vehicles would not be placed at risk. Will he confirm and place on record that the matters to which he is referring relate only to new motor vehicles?

Mr. Bottomley: Yes. My hon. Friend previously asked a question which I was delighted to answer, because there is some confusion in the minds of some people involved in vintage, veteran and old cars generally. The rule is that the new standards will apply to cars which are manufactured after the set date. Therefore, I confirm what my hon. Friend has just said. He has done the House and the country a service by raising that point. I hope that people will no longer write to my hon. Friend in his role as secretary of the House of Commons Motoring Club, or to me as Parliamentary Under-Secretary of State for Transport, asking us to reconfirm what we have already confirmed in the House.
The dates of application—1 October 1992 for new type approvals and 1 October 1993 for all new registrations —are two years later than those set for the application of the small car stage I standards imposed by directive 88/76. That reiterates and remakes the point my hon. Friend has already made.
The proposal is for a permissive directive under article 100A of the Single European Act. It has two purposes. It prevents any member state from setting unique national standards. At the same time, substantial progress is made

towards greater protection for the environment. The permissive nature of the proposal gives each member state the opportunity to set less stringent standards, or to delay the dates of implementation if it so desires. The United Kingdom Government intend to apply the new standards in full on the proposed dates and have negotiated on that assumption.
Surprisingly quick progress has been made in negotiations in Council and political agreement by qualified majority has been achieved, subject to several reserves, including a parliamentary one from the United Kingdom and an ad referendum one from France.
Earlier this year, we did not think that such quick progress was possible. That was made plain by the explanatory memorandum and the Scrutiny Committee report. Initial reactions to the Commission's proposal were mixed, to say the least. The United Kingdom shared a view held by all the major Community car producers except Germany, that the proposal was too strict. Others did not think that it went far enough. A minority voiced support for the proposal. The key figure is the combined limit for hydrocarbons and oxides of nitrogen. In directive 83/351/EEC, which sets the limits we currently apply, the standard is 19 g per test for small cars. The standard in directive 88/76/EEC, for small cars, stage I is 15 g per test. Some member states hoped to see a stage II limit of 12 g per test, while others preferred 5 g per test. The Commission's proposal, as it often does, almost splits the difference at 8 g per test.
These different limits would lead to different technical solutions. I think this is perhaps the most important part of the debate. At 12 g per test, most small cars could avoid the use of catalytic converters. Lean burn engine technology on its own would still be an attractive option. Several manufacturers have already developed models that can nearly meet this standard. It is not achieved easily. Although small cars could continue to use carburettors, they almost certainly would need sophisticated electronic ignition systems to achieve an acceptable balance between emissions, fuel economy and driveability.
Such systems are not cheap. I believe that it would be right to assume that their fitment would become commonplace in the 1990s. The reliability and long-term stability they offer would still be strong selling points, even if emission standards were not already pushing the technology in that direction. The Government initially saw the attractions of a 12 g per test standard—it represents a 37 per cent. reduction over the current standard at little real additional cost to the consumer.
The Commission's proposal of a combined standard of 8 g per test for hydrocarbons and oxide of nitrogen would impose the need to fit catalysts on almost all small car models. The need to fit controls of mixture strength, with electronic management of fuel injection, would be avoided. Systems could be kept simple, and lean burn engines would continue to be an option. When assessing the costs of a continued limit value of 8 g per test, the Government have used the 12 g standard as a new baseline.
We believe that the technology to achieve the 12 g standard will be available anyway. Our estimate of additional cost when the 8 g standard is fully implemented is about £250 million a year, or 3·5 per cent. of small car motoring costs. This fits in with the Commission's estimate of 4·5 per cent. increase in costs when compared with the current 19 g per test baseline. About £30 million of these


additional costs can be accounted for in increased fuel consumption. As modern engine technology becomes more sophisticated and efficient, such fuel consumption penalties can be expected to fall.
A combined standard of 5 g per test is another matter altogether. It is universally accepted that such a standard would be fully equivalent to current United States standards, and that the only proven technology to achieve it is the fully controlled, three-way catalyst with electronic engine management which holds the air-fuel ratio at a fixed level. The standard rules out entirely the possibility of the fuel economy benefits of lean burn. The Commission has estimated that small car costs would rise by 13 to 15 per cent. relative to the current standards. That is an enormous amount to the cost of motoring where the market is the most price sensitive.
There is no question about our needing to improve emission standards so that total emissions from motor vehicles can be contained and then reduced, in spite of increases in vehicle activity.
Detailed computer modelling of the effects of vehicle emissions on air quality has been carried out for the Department of the Environment by the Harwell laboratory. The standards the Government are already committed to apply—the medium and large cars standards and the stage I standard for small cars—are predicted by the model to achieve substantial reductions in nitrogen oxides and hydrocarbon emissions. As a result, peak ozone levels are expected to fall too. This is thought to be particularly important for sensitive vegetation.

Mr. Tony Lloyd: How far the Government seriously expect levels of pollution to decline is a fundamental point of the debate. Would the hon. Gentleman like to comment specifically on what estimates the Government base their claim that ozone levels will fall if this compromise is adopted?

Mr. Bottomley: The facts of the physical chemistry are not in dispute. It is expected that the 8 g per test standard compared to the 12 g will mean that the level of ozone harmful to the vegetation will be reduced by 6 per cent. more, the level of hydrocarbons by 7 per cent. and the peak ozone levels by an extra 2 per cent. Obviously, people can have their views on whether the limit can be reduced further. At 5 g per test, there would be a significant impact on the fuel economy of cars. That becomes important with small vehicles and even more important when we realise that half the cars sold in Europe are small cars. We need to look also at the costs to consumers. There is just as much cost benefit in ecology and the environment as in other respects.

Mr. Roger King: My hon. Friend is obviously aware that, no matter what system of engine management and combined catalyst one has, exhaust gases of some kind will come out the back of the vehicle. Usually, that will result in an increase in carbon dioxide emissions. Did the Commission bear in mind the concern, which has escalated as recently as the last few months, about the build-up of carbon dioxide in the atmosphere and the fact that this legislation will accelerate that process by the time European cars are converted to lean-burn catalyst devices? Does my hon. Friend agree that this will exacerbate a problem which is causing growing concern to everyone?

Mr. Bottomley: The Commission wants the Council of Ministers to be able to reach agreement. Britain has helped to lead the way towards general acceptance of the Commission's compromise between 12 g per test, which was put forward by Britain some months ago as the preferred level, and 5 g per test, to which some countries wanted the whole Community to move.
My hon. Friend the Member for Birmingham, Northfield (Mr. King) rightly says that one of the consequences of catalytic conversion is increased carbon dioxide. Increased fuel consumption is also associated with the 5 g per test. There seem to be significant costs above the potentially justifiable costs arising from the 8 g per test standard. Renewed concern for the atmosphere and for the greenhouse effect, led in Europe by my right hon. Friend the Prime Minister and my right hon. Friend the Secretary of State for the Environment, demonstrate that we need to be practical as well as idealistic.

Mr. Robert B. Jones: My hon. Friend referred to the academic research carried out, particularly at Harwell, on behalf of his Department. Is my hon. Friend aware also of the great volume of academic research being carried out into the very localised conditions caused by pollution from car exhausts? Where that is exacerbated by temperature inversions, much building damage occurs. I hope that my hon. Friend will bear in mind the consequences of pollution, not just in the very broad sense but in terms of local traffic management.

Mr. Bottomley: Anyone who works in this place will be aware of the effect on the buildings around here when traffic comes to a standstill around Parliament square. Hon. Members will he aware that the fumes pumped out do not just affect the buildings but may even affect the quality of some of our judgments as we do our work at 2.33 in the morning, or is it late evening? I do not know how one is supposed to refer to it.

Mr. Peter Pike: The Minister said that some countries advocated 5 g per test, as opposed to 8 g per test, which the British Government support. If the Minister thinks that 5 g is not a good idea, why did some countries believe that it was a reasonable and attainable proposition? What case did they make for it?

Mr. Bottomley: I do not want to get into deep water. These countries have coalition Governments. I make no secret of the fact that if we had a significant number of Green Members, that would show that our major parties had failed. Green issues should not be left to one party; they should be with us all. In countries with proportional representation minority groups may have more power, and may show it by demanding that their Governments commit themselves to programmes that are not cost-beneficial. It is far better to examine the science involved in going to 5 rather than 8 or 12 g per test. That is my answer to the hon. Gentleman's question; perhaps Opposition Members will advance others.
A stage II standard of 12 g per test would reduce nitrogen oxides and hydrocarbon emissions further, with a small decrease in ozone levels. At 8 g per test there is a jump in air quality impact. Hydrogen emissions would be controlled more than twice as effectively as by a 12 g standard, and ozone levels would be lower.
A 5 g standard would effectively mandate full three-way catalysts on all small cars. Compared with an 8 g standard it would reduce nitrogen oxide emissions but would have no significant effect on hydrocarbons or ozone.
A stage II standard of 8 g would lead to significant further improvements, and, for ozone, is probably close to the optimum that can be achieved by controls on small car emissions.
In consultations with the motor manufacturers the Government have been left in no doubt that their preferred outcome for the present negotiations would have been a standard of about 12 g per test. They have also recognised that European agreement at that level has become impossible, with many member states either supporting the Commission's proposal or wishing to go further.
Uncertainty in such a key area as vehicle emissions can be very damaging to industry. The detailed development of new engine specifications is one of the major tasks in preparing a new car for the market. When emission standards remain unresolved, manufacturers have no choice but to plan for several outcomes, since they must have models that they can legally offer for sale by the time the standard comes into force. That is wasteful of resources and should be avoided whenever possible. On balance, the advice that we have had from industry was that an early agreement at 8 g per test was preferable to continuing delay in agreement. It would allow the lean burn engine technology being developed by the United Kingdom manufacturers of small cars to show its worth, although oxidation catalysts would be needed as extra emission control equipment.
In the lead-up to last June's Environment Councils these considerations were leading the United Kingdom to reconsider its position in negotiations. We were aware that if we were to move, others might follow us. We were also detecting a willingness on the part of the Germans, who had the influential duties of the Presidency, to seek some sort of compromise.
It was in this climate that the United Kingdom decided, shortly before the first June Council, to be sufficiently flexible in its negotiating to be able to support the Commission's proposal if, by so doing, a qualified majority could then be assembled.
Member states that had stood with the United Kingdom in the 12 g camp quickly followed the United Kingdom lead to support the Commission's proposal. One other member state joined us from the 5 g camp. Others who wanted the 5 g per test limit wished to add conditions before they could agree to a compromise. The key conditions were, first, to commit the Council to a firm third stage for application some time in the 1990s at the limit of 5 g per test. Second, member states should be free to offer tax incentives to purchasers of cars that met the 5 g limit before the mandatory application date. Third, it was said that the revision of the test cycle to include high-speed driving sequences should be prejudged so that the Council agreed now on limits for the new cycle for medium cars in a way that forced the use of three-way catalyst technology for that category.
These three conditions were unacceptable to the United Kingdom and to several other member states. After some difficult negotiations, a qualified majority was able to support the Commission's proposal, with the addition of

an article committing the Council to review vehicle emission standards in 1991. Whilst taking note of some member states' desire for 5 g per test for a third stage, there is no commitment to such a limit. Those participating in the agreement—

Mr. Tony Lloyd: One of the countries that wants to pursue the 5 g test is Denmark. The Danes may seek to go it alone in some sort of Nordic agreement. What would be the British Government's response to that?

Mr. Bottomley: That is a matter for the Commission, which should take them to court. The same would apply to any country that tried to impose a standard beyond that agreed in the directive. It is a permissive directive that allows countries to come up to standards set in the directive, but not to go beyond. If I have that wrong—[Interruption.] I had hoped that by giving way there would not be too many speeches, but obviously I am provoking comment so I shall continue with my speech and then answer points raised in the debate.
Those participating in the agreement have also undertaken not to extend the use of tax incentives, which undermine the harmonisation of the market by creating the unique specifications of car models for sectors of the Community market in advance of dates set out in the directive.
On the test cycle, the Commission has reaffirmed its intention to make a proposal within the next year. The agreement is still not assured since the French believe that some improvement on the conditions surrounding it should be made. They have sustained their reserve, and we can expect further negotiation on details at the November Council.
We now have the makings of an agreement that still leaves many issues on vehicle emissions to be decided by the Council. We look forward to further proposals from the Commission on the high-speed cycle, evaporative emissions, durability testing and further tightening of limits on gaseous emissions from commercial vehicles and the introduction of particulate limits for large dieselengined vehicles, which are now a dominant source of black smoke in urban areas.
I say to all those concerned about the environment that there are opportunities for people to contribute. About 49 of the 50 people in every 80 who could use unleaded fuel do not do so. Most people have cars that can use unleaded fuel. Most people with those cars could save 4p to 6p a gallon. The numbers of petrol stations that have unleaded fuel are growing dramatically. Sales of two-star are falling and I expect most petrol stations to switch to supplying unleaded fuel. I ask everyone, whether in business or individually, to find out as soon as possible whether his or her car can use unleaded fuel so that we can get the lead out of the atmosphere.
To return to the emissions in the directive, we have made significant progress at a faster rate than we had hoped. The agreement will be good for the environment and will give the motor industry the opportunity to show us the real benefits of advanced fuel emission technologies such as lean burn. It is now up to it. I commend the agreement to the House.

Mr. Tony Lloyd: The Minister's comments tonight do not allow us to give even one cheer for the Prime Minister's conversion to a greener Britain and a greener Europe. Unfortunately, the Prime Minister believes that we can have bolt-on environmentalism—almost like a bolt-on catalytic converter—that can be assembled and make no difference to any other aspect of policy.
The agreement is a compromise that is fairly typical of many things that are happening within the European Community. It is a compromise at almost the worst possible level because it advances the argument hardly a jot and the cause of a cleaner and better environment scarcely at all. It is rather ironic that the translation of the letter from the Vice-President of the Commission, Lord Cockfield, should make the point that the Luxembourg agreement was premised with the view that the basic principles of future emission requirements of the European Community should be adapted by categories of motor vehicles so that the effect on the European environment would be equivalent to that produced by USA standards, taking into account different patterns of use for each category.
It is ironic that the Minister prays in aid the idea that there should be some approximation to USA standards when, in reality, under existing regulations—we are moving on from those—a car in the United Kingdom, on an annual basis, produces about eight times more hydro carbons, carbon monoxides and nitrogen oxides. Even under the new proposals, the smaller vehicles of less than 2 litres will produce about twice the pollution of an equivalent vehicle on the USA.

Mr. Bottomley: Is the hon. Gentleman basing his remarks on United States standards or United States car emissions? I understand that about half the cars in the United States which start off in theory meeting the regulations do not meet them shortly afterwards. That may be a question, as I said in my earlier remarks, of whether Britain is right to try to agree to measures which we will make happen, rather than do what others do, and pass laws but do not get people to live up to them.

Mr. Lloyd: Perhaps the Minister would care to say how many prosecutions there have been in Britain in recent years for emissions that transgressed existing laws. Most vehicles on the roads of Britain are in breach of existing regulations which prohibit emissions dangerous to health or which cause damage to property. Any vehicle on our roads that is pumping out carbon monoxide or nitrogen oxides of different kinds or hydrocarbons is already in breach of our regulations.
Even if the Minister says that that is a technical point—I concede that it is—he will be aware that one can walk outside this building at any time of the day or night and find lorries belching out exhaust emissions which fall foul of the Minister's pragmatic levels reached by negotiation. So as we in Britain do not control emissions either, it is disingenuous of the Minister to refer to the state of affairs in America, when the United States can point to a real improvement through emission control—an improvement which Britain cannot claim.
I speak of the irony of the Minister praying in aid the example of the situation in the United States and the approximation of this European compromise to it—ironic

because the European compromise is massively worse than the United States position—because this debate is taking place on the day when Lord Caithness has been signing the United Kingdom's acquiescence to a freeze on nitrogen oxide emissions which will have the effect that by 1994 —not by 1992 or 1993, as applies in this directive—those emissions from all sources will be cut back to the levels of December last year.
That may seem a great achievement, but there is a problem for Opposition Members, who regard the Prime Minister's conversion to environmental issues as being totally bogus, when we consider the situation in other EC countries. France, which has a generally had record in these matters, and Italy, which, in defence of the small car industry, has been as recalcitrant in the past as has Britain have agreed to support the more aggressive and more acceptable 30 per cent. reduction in nitrogen oxide emissions by 1994. The British Government, on the other hand, have said that they do not want to know about that level. So it is ironic for the Minister to claim that the British Government have credibility in this sphere when the rest of Western Europe is out of step with the Prime Minister's newfound environmental credentials.

Mr. Robert B. Jones: The hon. Gentleman makes much play with the commitment of certain other countries. The Soviet Union is a signatory to the 30 per cent. declaration. Should one therefore attach any credibility to that? Is it not better to approach this issue in the way the British Government have— to mean what they say and get down to the objective level instead of going along with political ploys, as do many Governments in Europe and elsewhere?

Mr. Lloyd: The credibility of the British Government is not high in this area. They have resisted any move towards more acceptable controls of pollution. The compromise now before the House, as I shall demonstrate, is unsatisfactory because it will not achieve the improvement in the environment that the Government claim that it will. It is ironic that the directive should come before the House today, given that last night—the night when the Minister discussed penalty points with me—it was recorded that at the York road junior school not far from here the World Health Organisation's recommended maximum of 10 mg per cu. m of carbon monoxide was exceeded. In the area of the Houses of Parliament the level of carbon monoxide was 11·3 mg per cu. m.
Most of the carbon monoxide in a city such as London comes from emissions from motor vehicles. In the period from 7 o'clock last night until this morning, at Bedford junior school near Heathrow airport, the World Health Organisation's recommended maximum for emissions was exceeded when 10·7 mg per cu. m were found. In the area of the York road junior school last night the World Health Organisation's recommended maximum nitrogen oxide level of 400 mg per cu. m was also exceeded. This morning, during the peak period of travel for commuters in London, the level reached 482 mg, which is way over the figure that the WHO finds acceptable.
I hope that the Minister accepts that the consequences for the health of those travelling through the area at that time may he serious. I hope that he will accept that it is ridiculous for the Government to lay claim to any credibility, given that we experience the physical impact of the problem on a day-to-day basis. I now remember what the hon. Member for Hertfordshire, West (Mr. Jones) said.
It is ridiculous to talk in terms of global or national limits. The problem exists in local areas, and particularly in London because of high traffic density.

Mr. Roger King: I do not say that such levels of pollution are in any way acceptable; of course they are not. However, it must be remembered that over the past few days, and last night, weather conditions were especially conducive to a build-up of pollution. We have had fog, temperature inversion and all the rest of it. Such conditions are exceptional in London. There is usually a wind so that exhaust fumes can dissipate. I hope that the House is not concluding from the hon. Gentleman's remarks that such pollution is an everyday occurrence with which we have to live, with the consequent danger to us all.

Mr. Lloyd: The hon. Gentleman seems to misunderstand what a maximum recommended limit means. It means just that. It is extremely dangerous for those in the vicinity when that limit is exceeded. There is some merit in the hon. Gentleman's argument that so far such events have been relatively infrequent, but in London the limits have already been exceeded twice in the past week.
The hon. Gentleman may want to talk about unusual weather conditions, but they are not so odd. It was predicted that the limits would be exceeded in November and December this year because the amount of nitrogen oxides and carbon monoxide being pumped into the atmosphere in London has increased year by year as a result of the increase in the volume of traffic on the roads of London. The Minister knows that some of the increase in the volume of traffic is due to the relative affluence of commuters in London but that much of it is also due to the Government's refusal to invest in public transport.

Mr. Peter Bottomley: Nonsense.

Mr. Lloyd: The Minister must accept that important point. He made some play of trying to justify lean burn engines in terms of national fuel consumption. He knows that there are far more efficient ways of reducing the national consumption of fuel—among them better and slower traffic systems and getting people out of motor cars and on to a more efficient public transport system.

Mr. Bottomley: May I abbreviate parts of this debate? Will the hon. Gentleman accept that the number of people commuting by car into London in the past six or seven years has fallen from 190,000 to 160,000, that the number of people using the underground each day has risen by 60 per cent. since it was taken back from the GLC, that the decline has been reversed in the number of people using the buses and that investment in the public transport system has been running higher than the investment in national roads? Almost everything that the hon. Gentleman has said is wrong. Why do we not come back to emissions and concentrate, perhaps, on the 5 g. and 8 g. standard? Perhaps he will accept that putting three-way catalysts on to small vehicles, with the fuel injection control equipment, is likely to worsen the fuel economy by 10 per cent., which will not only lead to extra carbon dioxide, but to increased fuel and fumes.

Mr. Lloyd: The last point is not true, because the difficulty of especially the lean burn technology is that it offers very little in the reduction of nitrogen oxides, and

that is the most fundamental criticism of that technology. It is an untested technology and cannot even guarantee to deliver what the Minister claims. It certainly will not reduce at high speeds the amount of nitrogen oxides that are pumped into the atmosphere. As nitrogen oxide is the most important of the three pollutants from vehicle emissions—because of its impact on acid rain and the creation of ozone in connection with hydrocarbons—the Minister cannot wriggle out of the problem simply by referring to fuel efficiency or cost.
The Minister waxes eloquent about the Government's success in transport, but the reason why tubes in London are overcrowded owes nothing at all to Government investment, but a lot to the Government's incompetence in the management of traffic systems in London. Because of the way that traffic operates in London, there is more pollution in the atmosphere now than there has been in previous years. That is a statistical fact which cannot be altered by any argument put forward by the Minister. I will let him think about that while his hon. Friend the Member for Stafford (Mr. Cash) speaks.

Mr. William: Does the hon. Gentleman concede that the clean air Acts were passed by a Conservative Administration, and that much of the argument that he is constructing in attacking the Government on this point is absurd?

Mr. Lloyd: The hon. Gentleman picked on someone from the wrong city to talk to about clean air Acts, because pressure for clean air Acts came from northern cities and from the Labour councils. Labour councils were putting pressure on a Conservative Government that operated down here, but it was their pressure that led to those Acts. The hon. Gentleman should know that Manchester, which has been Labour-controlled for far longer than the hon. Gentleman has lived in a northern city, took the lead in clean air matters.
The specific question must be where we go from here, because the present EC compromise will not begin significantly to reduce the amount of environmental pollution caused by vehicle emissions. When we study the Warren spring calculations of the impact of nitrogen oxides by the end of the century, we see that, if the present Luxembourg compromise is brought into effect, the reduction will be 12 to 32 per cent. If three-way catalytic converters are introduced, the reduction will be 60 to 70 per cent. We are told by environmental scientists that that is the sort of level that will be necessary if we do not simply maintain our present position, but we begin to undo the damage of the impact of acid rain. The Minister must deal with that because skirting around and saying that we can achieve stability is not satisfactory. Stability is not a position of credibility if we are to take seriously the Minister's cost balance of trading off cost and improvement. We will not improve if this order is to be the full stop for Western Europe.
The Minister must recognise that if the directive comes into force in the early 1990s, its full impact will not be felt until well into the next century. Even in 1992 or 1993 any attempts would mean that we delay the inevitable need to take any practical action until 2010 or even after that. We are playing with a 20-year time scale that we do not have.
There is no sense in allowing permissive legislation of this kind —

Mr. Iain Mills: I should like to ask the hon. Gentleman one small question. What is the Labour party's policy on exhaust emission and has it been discussed with the car manufacturers and the trade unions? Will the hon. Gentleman tell us what he would do?

Mr. Lloyd: I think that I have made quite clear what I would do, but I shall spell it out to the hon. Gentleman in case I was not clear. We would press for the introduction of three-way catalytic converters on all new motor vehicles because that is the only way that we can begin to tackle the problem of vehicle emissions.
Conservative Members will obviously want to pray in aid all sorts of bogus statistics, but the most important statistic is that a third of the world's vehicles are now fitted with a technology which was developed in Britain but rejected by British Governments on the most ridiculous grounds. That third of the world includes the United States, Japan and Australia. The technology is already there and will, inevitably, have to be imported into this country at a later stage. I hope that that makes what I am saying clear to the hon. Gentleman.
The point that I was making before I gave way to the hon. Gentleman was that this permissive legislation does not offer a realistic prospect of improvement because permissive legislation is designed to prevent countries such as Denmark from introducing a more acceptable standard.
I readily accept the argument that one country's solutions are not totally adequate because pollution knows no boundaries. The Minister has made it clear that the British Government's view is that the Commission should take action against Denmark to prevent Denmark from trying to improve its own environment. That is an act of the utmost folly. Rather than trying to prevent the Danes from moving in that direction, perhaps the British Government should take seriously what the Danes are saying and move in that direction.
If we are to take seriously the problems caused by vehicle emissions, we will not achieve our aim by this shoddy compromise. If we are to begin to reverse the damage that has already been caused, we must be prepared to embrace a more radical technology. The Government are clearly not prepared to accept that and in being unprepared to take that step they are making it clear that the Prime Minister's recent claims of an interest in the environment are as bogus as most people in this country thought that they were.

Mr. Malcolm Bruce: Some of the interventions that we have heard from the Government's Benches have convinced some of us that one speech does not change a party. The Government will have to come up with something rather more forceful than they have yet produced if they are to convince the wider public that the conversion to green issues will bear fruit in any radical changes in policy, rather than in attempts to justify policies that will be pursued anyway. One of my party's supporters has commented that it is apparent that the Prime Minister has developed green edges but that only time will tell whether that turns out to be mould.
We are debating some fairly mouldy proposals because, as the hon. Member for Stretford (Mr. Lloyd) said, the Government are supporting a compromise permissive resolution of the European Commission which simply freezes the agreed emissions for 1994 at last year's level. If

we are supposed to accept that as a radical new departure and a great new "greening" of the European environment, I for one am less than convinced of it.
The Minister acknowledged that other countries want to go further. He had the grace also to acknowledge that this compromise goes further than Britain had originally wanted. It is now being accepted on the basis that any agreement is better than no agreement, especially if it is an agreement that does not cause us too much trouble, does not cost us too much and is not very inconvenient—it is only permissive.
The European Parliament's environment committee was pushing for 5 g and 20 g limits which are still substantially higher than the limits accepted for many years in the United States. The Minister argued that it was all very well for the United States to set those limits, but they were not necessarily enforced and did not necessarily produce significant achievements. The United States monitoring system has suggested that, at least since the more radical proposals than we are debating were introduced 18 years ago, the quantities of the relevant gases in the United States atmosphere have reduced by one third in one case and 6 per cent. in others. Those are measurable reductions, but no one is suggesting that they are closely connected with the measures.
The standards adopted in the United States have been taken up by Canada, Japan and Australia and are being taken up as objectives by other European countries. As this motion proves, Europe is collectively lagging behind the rest of the world. Britain was conspicuously absent from the declaration in Sofia. That was only a declaration of pious intent, but the fact that we are not prepared to make such a declaration suggests that we are a long way from achieving radical changes.
The harm done by these gases is no longer in dispute. In debates on environmental pollution, the Government have sometimes argued that there was no proof that particular emissions cause problems and that, until there was proof, they were not prepared to take any action. The situation should be reversed. It does not require a great deal of scientific research to know that exhaust fumes are noxious and that maximum control over those emissions, to ensure minimum pollution, is desirable.
How do we achieve a sensible balance? For a number of years, the Government, backed by the motor manufacturers, have argued that that they do not want to become involved in catalytic converters. They want to develop the lean-burn engine as British technology, again ignoring the fact that the catalytic converter was British technology. However, the people of Europe do not have time to wait. That is not to suggest that this development should not continue or that the lean burn engine does not have a contribution to make, but it is not ready to go into commercial production. One wonders why a company such as Ford appears to be so resistant to the idea of catalytic converters here, when it has accepted them in its home base because the legislation decreed that. How did Jaguar manage to cope with a successful export drive to the United States, meeting United States standards?

Mr. Roger King: That was as a result of legislation.

Mr. Bruce: That is exactly the point. Legislation and pressure to raise standards force the pace of technology


and develop the ability to meet those standards at a cost-effective level. The cost of introducing such changes is often lower than forecast.

Mr. Roger King: I do not think that the hon. Gentleman has read the document that we are debating today. He talked about Jaguar, but we have already dealt with that kind of car which will be fitted with three-way catalysts. We have dealt with cars of 1·6 litres to 2 litres and tonight we are talking about cars of 1·4 litres and below— a type of car which is not freely available in the United States where the system of three-way catalytic converters is more suited to the large V8 car or our export Jaguars, BMWs and Mercedes. However, with the smaller cars, such as the Metro and the Mini, there are problems in fitting these installations. The hon. Gentleman should address those problems and note that Ford already has a lean-burn engine in production.

Mr. Bruce: It is true also that Ford has said that if it were required to introduce catalytic converters, it could and would do so. I do not dispute the specific terms of reference of the document and supplementary explanatory memorandum that we are discussing, but it should be said that on previous occasions manufacturers have resisted changes of this sort. They have not wished to make them, but when put under pressure they have been able to respond in a cost-effective and technically acceptable way. Pressure in the area with which we are concerned would produce similar results. Many who are pressing for change know that that is the position. As long as pressure is not produced because Europe cannot agree to proceed to sufficiently restrictive standards, the technology will not be developed and the necessary cost reductions will not be achieved.
The Minister referred to the gradual phasing out of two-star petrol and the gradual growth of availability of lead-free petrol. Perhaps we should look to the West German example and ban two-star petrol. The Minister's ministerial colleague and wife, the Under-Secretary of State for the Environment, has said that that would be undesirable because users should have choice. The Minister has said that the problem is that we have lead-free petrol and that motorists are not using it. The Government should be considering how they will hasten the process.
The Select Committee on Trade and Industry, of which I am a member, has recently investigated petrol retailing. It found that the introduction of lead-free petrol with wide availability is proceeding at a relatively slow pace. It will be about two years before there will be sufficient distribution to unleaded petrol outlets to make consumers feel confident, especially if they live in an area such as my constituency, which is a large rural patch, that unleaded petrol is freely available.

Mr. Peter Bottomley: It is probably better that I make an intervention in the hon. Gentleman's speech and not wait to deal with the matter when I reply to the debate. A motorist will know that his car does not have a catalyst because he will be aware that he can put ordinary two-star or four-star petrol into the fuel tank. Anyone whose car can use unleaded fuel without adjustment, or after having been adjusted, and who finds that unleaded fuel is not

available will be able to use ordinary two-star or four-star petrol. He will find that it will have no noticeably different effect on the engine.
I hope that the hon. Gentleman will help my colleagues in the Department of the Environment and myself, as well as CLEAR and Friends of the Earth, to deal with the appalling ignorance, as well as apathy, which is preventing motorists from having their cars converted so that they are able to use unleaded fuel and then using it. If a car can use unleaded fuel, it can also use leaded.

Mr. Bruce: I accept that that is a useful contribution to place on the record. In a sense it reaffirms my argument that the message is not getting through. There is a lack of knowledge, understanding and action. It seems that potential users are not responding. Indeed, the oil companies are not responding.
The Minister has said that if someone has had his car converted so that it is able to use unleaded petrol, his natural wish will be to buy unleaded petrol for economic and other sound reasons. I accept that what the Minister has said is true, but I think that he will accept that users will be looking for outlets with unleaded fuel. The sooner that they are available throughout the country, the sooner we shall be able to speed up conversion and use. There is no doubt that it is accepted that the lead emissions in car exhaust fumes are inflicting considerable damage to both the environment and human beings.

Mr. Robert B. Jones: Surely we need to deal with the inertia factor in the use of unleaded petrol. Surely it would be sensible to persuade or if, necessary, to legislate for car manufacturers to produce cars that will use unleaded petrol so that users do not have to go to the trouble or expense of having them converted to enable them to use leaded petrol. Would not that be a major step forward?

Mr. Bruce: I am sure that it would. I am sure that we have established a useful understanding across the Floor of the House. I am saying that we can deal with the problem through legislation, the raising of standards within areas of known technology and the forcing of the pace of technological and social change. The proposal from the hon. Member for Hertfordshire, West (Mr. Jones) is perfectly sensible and reasonable. The Government may have to take the suggestion on board and it may require legislation which I hope will be forthcoming if it is needed.
I do not think that anyone can now fail to be aware of the serious concerns about the consequences of acid rain and lead pollution on the physical environment in Europe. It is interesting to note that when the West Germans saw the trees in the Black Forest suffering and dying they thought initially that the cause was British power stations. Subsequent findings caused the West Germans some embarrassment over their initial hypothesis. Incidentally, I have friends in the Black Forest area and I witnessed the damage to the trees, which were a pitiful sight. The West Germans put a lot of pressure on us. In case I am misunderstood, I must state that I believe that British power stations contributed to the problem in West Germany.
It was interesting that the West German research showed that their biggest single problem came from pollution from car exhausts. Once that was brought home


to them, they acted more speedily as they have a high proportion of high-powered cars to which catalytic converters could easily be fitted.
This has been a very lacklustre debate about a proposal over which no one can get very excited. It is a pretty lame, rough old compromise and it does not really force the pace on the issue anything like far enough or fast enough. I am worried that the directive may well be taken as the marker for all that we have to do over the next five years. If that is the case, it is a very inadequate marker. We should be forcing the pace. If the British Government want to take up those green issues, they should accept that they should take a lead. To pretend that a loose compromise which is further, sharper and more radical than what they originally wanted is some kind of radical initiative that arose from the Government's forward thinking is simply not credible.
We will still be operating at standards of half the United States level. The proposals are only the beginning of the debate. The European Parliament environment committee will want to force the pace. The fact that others like France are being disruptive should not allow us to use the disruption as an excuse to settle for a compromise that takes us nowhere. The Government must accept that they should look ahead and recognise that the commitment to the lean-burn engine will not solve the problem, but will make only a contribution to it. We must think in terms of the standard objective of reducing emissions by 30 per cent. plus over the next five years. I hope that the Minister will come back to the House well within the five-year period with radical proposals from the Government on how a 30 per cent. reduction can be achieved. The present proposal makes no contribution to that.

Mr. Alan Haselhurst: I must first declare an interest as I am adviser to Johnson Matthey plc. I am also a member of the Select Committee which recommended that the House debate this matter. We have had an interesting if somewhat low-key debate. Perhaps that is explained by the late hour.
I welcome the Government's realism in the way in which they have moved on the proposal within the confines of the political constraints in the Community. At least we are taking a step forward in the right direction. We should not approach the subject in a spirit of hesitancy. We should understand that, without making party political points, there is growing recognition of the need to protect our environment. Pressures for further improvement will grow. Therefore, the spirit of the House in approaching the matter should be to support and encourage the Government to press on as fast as they possibly can.
It is understandable that, being responsible, the Government must recognise that the British car manufacturing industry must adjust to such changes, but I hope that it will equally be recognised that some car manufacturers are already prepared to go faster on this issue, even if they are not all prepared to move at the same time, and so there are signs that the industry is coming round.
My hon. Friend the Minister said that there is a desire for certainty, which the Government have recognised and which he dealt with in his opening speech. The Government are also concerned for the consumer, but I

wonder whether added costs that might come from pressing on not only with this proposal but going further eventually would be too severe a deterrent. If people are to become more aware of the need for the protection of the environment, they might be prepared to pay an additional sum in order to ensure that they were making their contribution.
I do not want to be controversial, but we spent the earlier part of today discussing why charges should be imposed for dental check-ups and eye tests and it was suggested that people would pay those charges because they would be in their interests. It could be said that they might not be completely put off by having to pay a bit more. But if the Government did think that they would be, they have a weapon that might help to alleviate the problem.
I am not clear that we are obliged by Community law to impose a car tax. If the Government want to help in adjusting to the change, it would be possible to tinker with the car tax without at the same time causing a boost to consumer demand if the price of more environmentally friendly cars were to increase because of the adjustments made to them.
My hon. Friend made an impassioned plea for greater use of lead-free petrol. This is national lead-free petrol week. I endorse that because it is the obvious preliminary to some of the other changes that will have to take place if car engines are to become cleaner. I urge my hon. Friend and his colleagues to persuade my right hon. Friend the Chancellor of the Exchequer, when he next considers these matters, that he should go much further in what he has already done because the gap between lead-free petrol and leaded petrol in countries such as Germany is much greater than it is here.
When it is possible, by shopping around, to see a spread of between 12p or 14p a gallon on leaded four-star petrol, the difference that we have instituted so far. which I welcome, will not be a positive attractive incentive to people to change over. That could be achieved at no cost to the Excheqer if adjustments were made by increasing the duty on leaded petrol and reducing it still further on unleaded petrol. There must be an equation at some point where that could be done at nil cost to the Exchequer. But there would not be a great cost to the Exchequer, nor would it add to the consumer demand which is causing the Chancellor concern at present, if there were a substantial reduction in the duty on unleaded petrol so that there would be a clear incentive for people, other than that of good sense and care for the environment, to switch over to it.
That would be an important boost to the campaign which my hon. Friend and his colleagues are trying to press at the moment. The Government would make their enthusiasm on this subject clear beyond all doubt in a means that they have at their disposal which is not conditional on the support of any other Government in the Community.

Sir Hal Miller: The Opposition's curmudgeonly attitude quite took my breath away, so much so that I was almost bereft of speech until I reflected that their attitude could lead only to the conclusion that they would join us in supporting the construction of


further nuclear power stations as the only environmentally acceptable way of power generation to meet the growing needs of our economy and country.
The way that the Opposition appear blithely to ignore the 25 million driving licence holders and the owners of more than 20 million cars in Britain is staggering. Their mathematics seem to be at fault. Perhaps my hon. Friend the Minister, to whose work I pay tribute, could confirm that the shift that he is announcing represents a reduction of more than 30 per cent. on the figures obtaining in the first stage programme, from which we are now moving more rapidly than originally envisaged. How we can be chided for achieving more rapidly a reduction in excess of 30 per cent in the face of a difficult political situation in the Community strikes me as odd.
Pace my hon. Friend the Member for Saffron Walden (Mr. Haselhurst), the Opposition's devotion to the cause of the catalyst also strikes me as odd, as my hon. Friend the Member for Birmingham, Northfield (Mr. King) briefly remarked, because the experience of looking after catalysts leads us to suppose that we have a long way to go, not only in terms of education, but perhaps, I fear, of regulation, on the efficient continuing maintenance and use of catalysts, particularly as related to small cars. They are of course already fitted to larger vehicles.
We should like to know what the European Parliament has said about this matter because the documents before the House state that a decision is still awaited. That was in July, so I wonder whether there is any news of what was decided.
We are retrospectively debating these issues because decisions are being taken on the continent by majority vote. By the time those matters reach us, they have already been settled. That is why the Opposition's strictures are even more absurd. To chide the Minister for having moved his colleagues is a very curious way to proceed. I support my hon. Friend the Minister, if only because of the certainty that is being offered to our manufacturers—and the need for such certainty could not be more clearly illustrated than by the recently announced engine facility, with more than £350 million being invested by the Ford motor company. I wish my hon. Friend the Minister every success in his efforts.

Mr. Peter Bottomley: I am grateful to my hon. Friends. It is worth noting that, as this debate concludes in the early morning, there are present 12 Government Members, but that the Liberal, the hon. Member for Gordon (Mr. Bruce), has no supporters, and nor has the Labour Member, the hon. Member for Stretford (Mr. Lloyd). Yet we are supposed to believe that the environmentalists are not on the Government Benches.
The Royal Society speech of my right hon. Friend the Prime Minister was a reflection of the Conservatives' interest in the environment. We do not deny that other parties also have an interest—we just wish that they would manifest it more often and in greater numbers. Looking around this Chamber, it is evident that we not only outnumber the other parties—that might be expected—but also that we outnumber them by a factor of seven or eight to one. We also outdo them in our understanding of the subject.

Mr. Tony Lloyd: Will the Minister educate the House on one important point? If he wants serious discussion of this issue, why was this debate arranged to begin at 20 past two in the morning, thus preventing any serious discussions? Also, will the Minister respond to the question put by his hon. Friend the Member for Bromsgrove (Sir H. Miller): why are we discussing this matter now—after the event, rather than before?

Mr. Bottomley: I explained the reasons at the beginning of this debate and I am happy to do so again now. However, I want to deal with the 30 per cent. point raised by the hon. Member for Gordon. The 20th report of the Select Committee on European Legislation of 30 March states:
The application of Directive 88/76/EEC in combination with a 12 grammes/test standard for small cars would give a 53 per cent. (HC+NOx) average limit reduction for all cars, when compared with the current 83/351/EEC Directive limits.
That provides some encouragement.
In this Parliament, we should try dropping some of the adversarial politics that may be necessary in other debates. This is a take-note motion on a Community proposal that is almost a British-led compromise. We have brought other countries together in arriving at the 8 g test standard and that deserves some recognition—even from the hon. Members for Stretford and for Gordon. I believe that the whole House welcomes the movement towards an 8 g standard and Britain's leadership in persuading other Community members to arrive at that acceptable compromise.

Mr. Tony Lloyd: It is rather curious that last night when the Minister was being savaged by his own side the only person who spoke in his support was me, from the Opposition. For him to argue that in no circumstances is there agreement across the Chamber is ridiculous. I must say, however, that there is no all-party welcome for this agreement: it is rubbish, and we have made that clear.

Mr. Bottomley: Now we have the Socialists in Britain saying that the agreement is rubbish. I thought that when Jacques Delors came to speak to the Socialists they turned around and began to accept that Community agreement would be good not only for our common European environment but for our common European car and engine manufacturing, as my hon. Friend the Member for Bromsgrove has said. Because we are becoming increasingly efficient in this country, we have more to gain in terms of both manufacturing and being able to trade across Europe without unnecessary barriers.
My hon. Friend the Member for Saffron Walden (Mr. Haselhurst) put a very fair argument. He mentioned his interest in Johnson Matthey, which the House acknowledges; but he also talked about a sensible approach. I think that it makes sense to go for the oxidation catalyst on small cars, with the 8 g per test limit, and developing lean burn. I said in my opening remarks that we could not expect the lean burn technology automatically to work, and that it was up to those developing it to prove that it would meet the standards. We are perfectly aware that if it does not, a different approach will be necessary.
Let me return for a moment to the subject of unleaded fuel. My hon. Friend talked about the need for an increased differential, but I feel that the existing differential can work. Unleaded fuel is being supplied by some major firms—such as Tesco, which is never knowingly undersold.
Even the cheapest petrol station in the constituency of my hon. Friend the Member for Surrey, South-West (Mrs. Bottomley), the Jet petrol station on the way to Godalming, sells unleaded fuel. I think we shall see more and more competition involving not only the major fuel companies but the smaller ones as well.
I am delighted to announce that I have made arrangements for a sign to go up as soon as possible on every motorway where there is a motorway service area selling unleaded fuel saying that it is for sale there. I think that that will help to get the information across.
According to a newspaper report, when the director of Friends of the Earth was asked whether he had a car, he said no. When asked if his wife had a car, he said yes. When asked it he used it, he said occasionally. When asked if it used unleaded fuel, he honestly said that it would soon. That is the problem. If our "greens" in Friends of the Earth need a bit of reminding from a newspaper journalist, think how many of the rest of us need to have our cars adjusted. I am delighted to learn that manufacturers such as Ford and Vauxhall have arranged for the conversion to be done virtually free, or free in most cases. I would ask all other manufacturers to find out whether their cars can use unleaded fuel and to put a sticker—preferably green— on the dashboard and fuel cap to make sure that people buy unleaded fuel, because it saves money and the environment.
It has been suggested—I am grateful for the help of my hon. Friends in this regard—that if we want emissions reduced, we must go for a greater element of nuclear fuel. It is a straight fact that that is one of the ways of reducing the greenhouse effect. Otherwise, people are opting for conventional pollution. My right hon. Friend the Secretary of State for the Environment made that point in some excellent replies to questions put to him on Sunday by Jonathan Dimbleby.

We should also try to make the Opposition realise that they can approve of something that is being agreed in Europe. That is what this take-note motion is about. The hon. Member for Stretford and I will continue to have debates while I have my job and he has his position, but he might try to discover from the leader of his party whether that party is in favour of more road spending or against it. It is rather odd to read many reports saying that we are spending too much on roads and others saying that we are spending too little. The Leader of the Opposition seems to be saying that we are spending too little. I do not want that question answered now, but it would be useful to learn the party's view in the future.
The hon. Member for Gordon says that we are trying to put forward a freeze at last year's level for 1994. The position is exactly the opposite. The 12 g per test limit would bring about dramatic reductions in emissions and pollution. Moving to 8 g per test will go even further. The reports of the Select Committee on European Legislation suggest that we may have been going too far already. I consider that the 8 g per test is easily defensible, and I should like a bit more help from the Opposition in avoiding the tag that Britain is the dirty person of Europe. Because we make agreements that we stick to. we are ahead of many other countries.
I give the hon. Member for Stretford this challenge. Perhaps he should take a bit of water out of the Rhine and a bit of water out of the Thames and decide which he wants to drink.

Question put and agreed to.

Resolved,
That this House takes note of European Community Document No. 4637/88 and the Supplementary Explanatory memorandum submitted by the Department of Transport on 8th July on air pollution by the gases from the engines of motor vehicles; and supports the agreement reached at the 28th and 29th June Environment Council in Luxembourg.

Industrial Chemical Premises

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Fallon.]

Mr. John Ward: May I first thank my hon. Friend the Under-Secretary of State for Employment for being present to answer the debate at this late hour?
Although the reasons for the debate are mainly concerned with an incident that took place in my constituency, the lessons learnt from that incident could have much wider application on a national basis in ensuring that other towns do not have to go through the same experience as some of my constituents did last June.
It would be helpful if I set the scene and gave the background to the fire and explosion which took place in BDH Limited's chemical works at West Quay road in Poole on 21 June this year. The fire broke out in a building used as a chemical store at the factory. The building was constructed in 1982 and was divided into three sections —one used for storing oxidising substances, a larger area used as a main chemical store and a smaller area used as a flammable solids store. The three sections were separated by concrete block walls. Immediately outside the oxidising substances store was a bonded and protected area used for the storage of flammable liquids in drums.
At about 6·15 in the evening of 21 June a fire was discovered in the oxidising store and it took hold of that area rapidly and spread to the adjacent area containing flammable liquids.
Many hon. Members will have seen the television news reports of the fire, showing a large fireball accompanied by a plume of yellow-brown smoke rising over the old town section of Poole. In addition, some of the drums of chemical liquid exploded and travelled up to 300 ft in the air before falling back to the ground, some within the factory premises and others outside. At the peak of the emergency, some 100 firemen were in attendance, together with police and ambulance services and other local organisations.
Because it was not known precisely what chemicals were involved in the blaze— I shall refer to this later—a decision was made by the police and fire brigade to evacuate more than 2,500 people from the area and emergency centres were opened at Poole arts centre and the Henry Harbin school for their accommodation. This was the biggest mass evacuation in the United Kingdom since the second world war. The residents were not allowed to return to their homes until 5.30 the following morning.
The police and fire brigade officers who took the decision to order the evacuation are to be praised for their clear thinking. The back-up services which ensured that the operation was carried out smoothly and without undue distress to those concerned were a model of how such an operation should proceed. Again, I shall refer later to their activities.
I visited the site the morning after the fire and again during the clear-up operations and was impressed with the quiet efficiency of all concerned, but I have to acknowledge that there was also a sense of profound relief that what could have been a major disaster had, with a certain amount of good fortune and a great deal of skill from the emergency services, been contained so that most of the damage done was to property rather than people. If I do not describe the events of the night in great detail, it is

because they are already on the record and I believe that we now have to examine them to learn what action we can take to prevent such an occurrence in the future, either in Poole or elsewhere.
Before leaving the events of 21 June, it would be wrong if I did not put on record the admiration and gratitude which all the citizens of Poole feel for the many people who helped that evening. I have already mentioned the police and the fire brigade. Others who gave valuable assistance were Poole district council staff, the county emergency planning officer and his team, the staff of the Poole arts centre, who opened their doors to the evacuees, and the cast of the show which was appearing at the arts centre at the time, the New Vic theatre company, who put on a free show for the evacuees in the arts centre starting at midnight. The WRVS lived up to the high esteem in which we have always held them, as did the St. John Ambulance Brigade and the Red Cross.
Poole general hospital staff were both helpful and co-operative, as they always are, and so, too, were the bus operators who helped with the evacuation. Wessex Water was immediately on hand to ensure that drinking water supplies were protected and that there was no pollution of Poole harbour, and the Poole harbour commissioners rendered valuable assistance. The gas and electricity services worked tirelessly to make apparatus safe and to ensure supplies, and the Royal Marines, Poole, helped by providing such things as bedding material for those evacuated to the Henry Harbin school. It was a model of what should take place in a well-planned emergency operation of that nature, and I hope that any other local authority in the country which has any doubts about the need for good, planned emergency procedures to deal with such incidents will learn from the lessons of Poole.
The Health and Safety Executive has conducted an inquiry at the request of my hon. Friend the Under-Secretary and I should like to refer to some of the conclusions that it reached, which were published in the form of a summary of its inquiry report, with a press release, on 17 October. The primary cause of the fire appears to have been a lack of proper segregation of chemicals in the store concerned, which led to a rapid and violent spread of the fire. It has been the practice of BDH for a number of years to accept out-of-time and unwanted chemicals in even very small quantities from customers and to dispose of them as a service to those customers.
It appears that some of the chemicals which had been returned and awaited sorting were not compatible and should therefore have been separated immediately, but that was not done. Because of the massive destruction in the immediate area of the fire, the Health and Safety Executive was unable positively to identify the cause of the fire, but the summary of its report suggests that a probable cause was the leakage of strongly corrosive substances on to organic materials, or exothermic decomposition of stored material. It concludes that incompatible materials had been placed too close to each other because the sorting system for returned chemicals had become overloaded. That probably resulted in the fire which took hold extremely rapidly and with violent consequences. The fire penetrated the exterior walls of the immediate store and overheated drums of flammable liquid stored outside the oxidising store. The HSE also said that the decision to locate oxidising materials close to flammable liquids was flawed because, although the building was originally built


to the building regulations in force at the time, it did not conform to Health and Safety Executive guidance issued subsequently.
The HSE concludes that the storage practices adopted by the firm failed to cope with the problems created by the need to store and dispose of such a vast range of chemicals. It says that the public were not at risk from the drums of cyanide stored elsewhere in the building.
The HSE supports the police and fire brigade decision to evacuate the public because there was a mixture of a wide range of chemicals, some of which might have been hazardous and some of which were unidentified at the time of the fire.
I should like my hon. Friend to comment on the following matters. The full report has not been made public. Although I am sure that the HSE has done its best to provide an accurate summary, like all summaries it leaves a number of points unanswered, and I urge my hon. Friend, even at this late stage, to use his best endeavours to have the full report made public.
I hope that my hon. Friend will not underestimate the real sense of fear that will persist in the old town of Poole until the rumours which feed on part information are countered. I believe that my constituents are as entitled as anybody else to know exactly what the HSE inquiry revealed, whether or not it proves embarrassing to other parties. I am supported in this view by Poole borough council which, at its meeting a few hours ago, expressed its disappointment that the full report has not been published and gave its full support to my request to my hon. Friend the Minister.
My hon. Friend will be aware that on 15 July I asked him whether he would ensure that the results of the inquiry conducted by the HSE would be made public and whether he would set up a public inquiry. He said that a summary of the results would be made public. That has been done. He also said:
I do not propose to set up a public inquiry since this would be unlikely to identify any causes or contributory factors which will not be identified by the HSE investigation." —[Official Report, 15 July 1988; Vol. 137, c. 383.]
I tend to agree with the last sentence of my hon. Friend's reply, but I hope that he will understand that the summary of the report issued by the HSE prompts a number of questions and it has certainly not satisfied members of the Poole residents association, who are still calling for a public inquiry. They have told me that they consider that there are questions still to be asked which are not answered in the HSE summary. It is ironic to consider that, if lives had been lost and we had had a tragedy instead of a serious incident, there would almost certainly have been a public inquiry and all the evidence which is at present being withheld from public examination would have been given in open court.
Given that, so far, the report has not been made public, the summary issued by the HSE prompts me to make a number of observations.
A brief assurance is given in the summary that there was no danger to local people from cyanide and a reference is made to what is said to be a similar incident at River road, Barking in 1980. Frankly, without further information, that is not reassuring. Can we know whether the conditions were precisely the same, whether the dangers were similar and, in particular, whether, if cyanide needs to

be kept on that site in Poole, as I understand it may well need to be for some industrial processes, there was at any time any risk that it would affect the local population?
The HSE summary says that off-site damage was limited. I hope that that does not mean that it has ignored the fact that at another time of day, for instance, in the rush hour, when perhaps the bridge connecting old Poole with Hamworthy was open and with much more traffic on West street, there could have been considerable off-site damage with catastrophic consequences. It was also fortunate that many of the surrounding office buildings were empty at the time and even the wind direction that evening helped to limit the effects of the fire. I therefore regard the fact that off-site damage was limited as due to luck rather than skill.
Referring again to good fortune, the HSE summary says that the vast majority of fire brigade water was contained in surface water holding tanks and these presumably are part of the Wessex Water drainage system. No thought seems to have been given to what would have happened if there had been heavy rain before the fire or if the tide had been at a different state. In those circumstances, can we be reassured that harbour pollution, with its effect on both the amenities and the fishing industry in Poole, would not have been much worse?
The HSE summary refers to the fact that the building concerned met the building regulations at the time it was built, but there appears to have been no requirement to update it if the building regulations changed, and that is perhaps understandable. What is not understandable is that, subsequent to the construction of the building, the Health and Safety Executive issued guidelines which underlined the need for considerably more protection against fire than the building had at the time of the fire. I would ask my hon. Friend what provision there is for ensuring that HSE guidelines are complied with and, perhaps more important, what provision there is for ensuring that HSE guidelines are applied retrospectively in such areas where there is a danger to the public from the storage of toxic and flammable materials.
Although I understand the policy that it is for the commercial organisation concerned to devise and implement its own safety requirements, these should surely need HSE approval. The summary of the report prompts me to ask whether there is sufficient supervision in sufficient detail by the HSE. The summary of the HSE report recommends that all chemical companies ensure that their segregation policy for chemicals is clearly set out and fully implemented. Does this imply that there is room for doubt about whether this occurs as a matter of course? If so, surely everyone would agree that it is a matter for major public concern. My hon. Friend may well consider that this would lead to additional costs on HSE expenditure, but, with all the worries about environmental pollution at the present time, it would seem that there s a case for looking closely at the manning of this important Government agency.
I now turn to the actions of BDH since the fire. I should explain that it is a reputable firm employing several hundred people in Poole on two sites and that the firm has been a valued member of the Poole community since 1942. Immediately after the HSE press conference on 17 October, the company issued a statement in which it went further than the requirements now laid upon it by the Health and Safety Executive. It has agreed to remove all the chemicals arising from production from the West Quay


road site, and in future chemicals returned from its customers for disposal will go to other depots or be transferred straight to waste disposal sites. I believe that that will go a long way towards meeting the anxieties of my constituents.
The company has also agreed that the open drum store, which was the immediate cause of much of the damage and spread of fire, will be removed to another site and kept in a specially constructed store which will be fitted with automatic fire extinguishing equipment.
The company is preparing a detailed and comprehensive storage policy document, which I am sure it will discuss with the Health and Safety Executive, and any reconstruction of the chemical store which is needed will take place in accordance with conditions to be agreed with the Health and Safety Executive.
I believe that, following the fire, the company has behaved responsibly, and that it will continue to be a valued employer in Poole for many years. However, there are a number of lessons which I believe may well have application not only in Poole but throughout the country. I have already queried whether the HSE resources are sufficient to carry out the important task of ensuring that chemicals and toxic substances, particularly those stored in urban areas, are properly stored and recorded. It is essential that a list which is detailed and comprehensible to people other than chemists must he immediately available at every chemical store, for use by the police and fire brigade.
I believe that when guidance books are issued by the Health and Safety Executive which, in the light of experience, call for a tightening of regulations, some further consideration must be given to how all users of chemicals and toxic materials are informed and, more important, how the Health and Safety Executive will ensure that the new safety regulations are applied retrospectively. I have already referred to the value of proper pre-planned emergency procedures for such events as took place in Poole on 21 June. I hope that my hon. Friend will use his influence to ensure that all other local authorities learn the lesson.
As our chemistry research finds new materials, life will become increasingly complicated in the area of industrial safety, and I hope that my hon. Friend will think it worthwhile that the chemical industries and their trade associations should, together with representatives of the Government, continuously monitor safety requirements, particularly as they are applied in urban areas such as Poole.
I have spoken of the luck and good fortune associated with the outcome of the events in Poole on 21 June, but I remind the Minister that 2,500 of my constituents were evacuated from their homes late at night, experiencing considerable fear and distress, and I hope that he will appreciate that they will not be satisfied until the full facts surrounding the incident are made available to them. I therefore once again plead with the Minister that he should seek, with the agreement of the company if possible, to ensure that the whole report is made public. I believe that, following their experiences on 21 June, my constituents deserve nothing less.

The Parliamentary Under-Secretary of State for Employment (Mr. Patrick Nicholls): I congratulate my hon. Friend the Member for Poole (Mr. Ward) on bringing this important issue before the House—despite the eccentric hour at which he has managed to do it.
The fire at the British Drug House plant in Poole on 21 June was a serious incident and I fully appreciate the concerns that my hon. Friend has expressed so eloquently. He was extremely prompt about contacting my office and making clear his worries; his constituents need be in no doubt about that, or about the steps that he has taken to bring the matter to my attention, to ensure that such an incident never occurs again.
I will do my best to return to my hon. Friend's detailed points, but first I will need to say a word about the regime of control measures covering the use of chemicals at work, because it is necessary to understand the context in which these events took place.
To say that life in an industrial society involves coping with processes and substances of great complexity and potential danger may be atruism, but it is an accurate statement for all that. Industrialisation brings great benefits, but at the same time it poses great hazards and risks. Fuels, for example, are a potent source of energy, but are also potentially dangerous because of their highly flammable nature. By the same token, no one seriously doubts the need for effective pesticides, but their very effectiveness derives from their toxicity.
The key issue which my hon. Friend has brought before us is how to enjoy the benefits of these substances and processes without putting in undue jeopardy the safety and health of the workers who produce and handle them or of the people, like those living near chemical plants or warehouses, who will be at risk if things go wrong. A balanced approach is required, and the framework for achieving that balance must be enshrined in law. It must maintain essential levels of safety, but avoid imposing unnecessary rigidities and costs.
The fundamental law in this area is the Health and Safety at Work etc. Act 1974. It places general duties on employers, and anyone else who is in control of a work activity, to safeguard the health and safety at work of all employees, and to ensure that the public are not exposed to risks to their health and safety. These general but very powerful obligations are further strengthened by a number of more specific regulations, many of which directly address chemical safety. Within that framework it is especially important to have specific systems of control for places where hazardous chemicals are concentrated in significant quantities.
Our approach—both domestically and in Europe—is to identify which substances—and, indeed, what quantities of a particular substance—are a hazard or risk, and then to set out the necessary precautions. Central to that approach are the Control of Industrial Major Accident Hazards Regulations 1984, which implement a European Community directive. Those apply to sites with the greatest potential danger and impose some stringent requirements. They include the submission to the Health and Safety Executive of detailed safety cases analysing hazards and risks, the preparation of emergency plans to protect people both on and off the site in the case of a serious accident, and furnishing information to people living nearby who might be affected by a major accident.
In addition, the regulations are now to be amended to apply to a greatly increased range of places, including many warehouses containing packaged goods.
As I have said, the regulations apply only to workplaces handling the most dangerous substances, but the Notification of Installations Handling Hazardous Substances Regulations 1982 apply to a larger group of chemicals and prohibit any person from using them unless he has notified the Health and Safety Executive at least three months previously. There are also other important statutes, like the legislation on fire precautions and pollution control and the town and country planning legislation, which serve to protect people from the hazards of chemicals.
The Health and Safety Commission is shortly to consider some possible further regulations that would require the notification of sites containing an aggregate quantity of 25 tonnes or more of dangerous substances and the erection of warning signs. Those regulations would assist enforcing authorities and the fire services in carrying out inspections, and most importantly would alert firemen to the presence of dangerous substances when they arrive on site, which is one of the specific points raised by my hon. Friend. Taken together, the regulations represent a system of graduated response, according to the severity of the hazard. They seek to give enforcing authorities and the emergency services the right degree of control, information and capability.
I hope that it is clear, from what I have said about the impending extension of major hazards legislation and the proposed regulations on notification and markings of sites, that we are far from complacent in this area. However, while the legal framework is essential, obviously it cannot be the whole story. What the law can do is to set conditions and make provision for enforcement, but what really matters are the working practices where chemicals are made, combined, stored or handled.
It is, of course, vital that those dealing with hazardous chemicals have a full understanding of their properties, not only on their own, but as they might interact. Chemicals that may be relatively harmless when stored separately can produce devastating effects in combination with others. That makes the proper segregation of groups of chemicals and the provision of fire resistant structures absolutely essential. Those, of course, were factors in the fire at BDH Ltd in my hon. Friend's constituency.
Having set out the general framework briefly, I should now like to address some of my hon. Friend's more specific concerns. The House has already heard some of the details concerning the explosion at the BDH plant. I agree with my hon. Friend that the severity of the incident should not be underestimated, and I should like to join him in paying tribute to the work of the emergency services and the many other organisations and individuals involved. There is no doubt that their calm and responsible action did much to mimimise the inconvenience and fear suffered by the residents of my hon. Friend's constituency.
In addressing my hon. Friend's specific points, I should first like to emphasise that the Health and Safety Executive carried out a very detailed investigation into the incident. It has produced a comprehensive report of its investigations and copies have already been made available to all public authorities with an interest in the incident. In addition, it held a press conference on 17 October when it made available to the public not only a statement but a detailed summary of its investigation.

Having seen both that and the full report, I should like to think that my hon. Friend agrees that the detailed summary gave a full and comprehensive list of the HSE's recommendations and conclusions.
While I appreciate my hon. Friend's point about a wider dissemination of the report, I must emphasise that the requirements of section 28(3) of the 1974 Act, which deal with matters of confidentiality, mean that the report cannot be published in full. But I was pleased to hear my hon. Friend agree that he did not see any advantage in setting up a public inquiry.
I am confident that the HSE's investigation was thorough and has gone as far as possible towards identifying the causes and contributory factors surrounding this incident. The House has already issued an improvement notice to BDH Ltd. to ensure that the key recommendation of the report is implemented, and I understand that the company agreed and accepted that recommendation. I was encouraged to hear my hon. Friend's description of the various actions taken by the company since the fire occurred.
However, I appreciate that the residents of Poole may still have questions that they wish to raise. I shall be more than happy to meet the Poole residents association to discuss with it any concerns which it has.
My hon. Friend raised a number of other points about the events at Poole. On the question of sodium cyanide, the HSE does not consider that this substance in itself presents a hazard in a fire. If it were to come into contact with an acid solution, cyanide gas may be given off, but I am advised that in a fire the heat involved would almost certainly destroy this gas.
I agree that there was some good fortune that the off-site damage resulting from this explosion was not more extensive. But it was also bad fortune that the incident occurred at all. The HSE and the public authorities involved are looking closely at the conclusions of the investigation and will obviously consider existing procedures in the light of this experience.
My hon. Friend also asked about the adequacy of the water holding system. I understand that the bulk of the liquid was contained within the effluent plant on site. Any fire water that was not contained went to the pumping plant, which has two holding tanks. In any case, the quantities of water involved would have significantly diluted any particularly hazardous substances, and any rain would only have helped this process.
I come to the question of the HSE's resources. My hon. Friend asked a number of times whether I was satisfied with the manner in which the HSE carried out its responsibilities and with the measures it takes to ensure compliance with new and existing safety requirements. I am fully satisfied that the HSE has sufficient resources to carry out its responsibilities and to monitor safety standards.
But I must also add that the prime responsibility for the prevention of accidents clearly lies with employers, employees and others at the workplace.
On any basis, the incidents at Poole which my hon. Friend has brought to our attention tonight were, frankly, terrifying and I well understand the concern which he and his constituents have had to ensure that such a thing should never happen again.
I hope that in what is inevitably a brief contribution in a brief debate I have been able to offer my hon. Friend some of the consolations and assurances he sought. I stress


again that I shall be delighted to meet the delegation he wishes to bring to me and to do what I can to set their minds at rest still further.

Question put and agreed to.

Adjourned accordingly at two minutes past Four o'clock on Wednesday morning.